The uneasy (and changing) relationship of health care and religion in our legal system

Robert K. Vischer

Theoretical Medicine and Bioethics
Theoretical Medicine and Bioethics

Absract
This article provides a brief introduction to the interplay between law and religion in the health care context. First, I address the extent to which the commitments of a faith tradition may be written into laws that bind all citizens, including those who do not share those commitments. Second, I discuss the law’s accommodation of the faith commitments of individual health care providers—hardly a static inquiry, as the degree of accommodation is increasingly contested. Third, I expand the discussion to include institutional health care providers, arguing that the legal system’s resistance to accommodating the morally distinct identities of institutional providers reflects a short-sighted view of the liberty of conscience. Finally, I offer some tentative thoughts about why these dynamics become even more complicated in the context of Islamic health care providers.


Vischer RK. The uneasy (and changing) relationship of health care and religion in our legal system. Theor Med Bioeth. 2013 Apr;34(2):161-70. doi: 10.1007/s11017-013-9248-2. PubMed PMID: 23546737

(Book Review) Why Tolerate Religion?

Robert Merrihew Adams

Why Tolerate Religion?

Brian Leiter. Why Tolerate Religion? Princeton, NJ: Princeton University Press, 2012, 192 pp. ISBN: 9780691153612

Extract
“Why tolerate religion?” The question is raised by someone who thinks there is something wrong about religion as such. To tolerate, Brian Leiter emphasizes, is to “put up” with beliefs or practices that one regards as “wrong, mistaken, or undesirable” (p. 8). His paradigm case of principled tolerance is one in which a “dominant group has the means at its disposal to effectively and reliably change or end [a] disfavored group’s beliefs or practices, and yet . . . acknowledges that there are moral or epistemic reasons . . . to permit the disfavored group to keep on believing and doing what it does” (p. 13). Forcibly changing or ending religious belief has commonly been extremely difficult or impossible to achieve by any means short of total extermination or banishment of the disfavored group, as history shows, and is therefore a really scary project. With his stated paradigm in mind, we might think that Leiter’s statement that “the contemporary problem, at least in the post-Enlightenment secular nations, . . . is why the state should tolerate religion as such at all” (pp. 14-15), would be ominous indeed if it were an accurate reading of political reality.

Adams RM. Why Tolerate Religion? [Internet]. Notre Dame (IN): University of Notre Dame. Notre Dame Philosophical Reviews; 2013 Jan 6.

Freedom of conscience and health care in the United States of America: The conflict between public health and religious liberty in the Patient Protection and Affordable Care Act

Peter West-Oram

Health Care Analysis
Health Care Analysis

Abstract
The recent confirmation of the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties.


West-Oram P. Freedom of Conscience and Health Care in the United States of America: The Conflict Between Public Health and Religious Liberty in the Patient Protection and Affordable Care Act. Health Care Anal. 2013 Mar 29;21(3):237-247.

Controversy, Contraception, and Conscience: Insurance Coverage Standards Under the Patient Protection and Affordable Care Act

Lara Cartwright-Smith, Sara Rosenbaum

Public Health Reports
Public Health Reports

Extract
In the end, although the ACA has made significant headway in expanding insurance coverage of contraception, the controversy surrounding religious and moral objections to contraception means that policy makers continue to struggle to ensure access to this important public health service while respecting religious freedom.


Cartwright-Smith L, Rosenbaum S. Controversy, Contraception, and Conscience: Insurance Coverage Standards Under the Patient Protection and Affordable Care Act. Pub Health Rep. 2012;127(September-October):541-545.

Rawls and religious paternalism

David M Shaw, Jacob Busch

The Journal of Medicine and Philosophy
The Journal of Medicine and Philosophy

Abstract
MacDougall has argued that Rawls’s liberal social theory suggests that parents who hold certain religious convictions can legitimately refuse blood transfusion on their children’s behalf. This paper argues that this is wrong for at least five reasons. First, MacDougall neglects the possibility that true freedom of conscience entails the right to choose one’s own religion rather than have it dictated by one’s parents. Second, he conveniently ignores the fact that children in such situations are much more likely to die than to survive without blood. Third, he relies on an ambiguous understanding of what is “rational” and treats children as mere extensions of their parents. Fourth, he neglects the fact that those in the original position would seek to protect themselves from persecution and enslavement and thus would not allow groups of children to be killed because of their parents’ beliefs. Finally, Rawls makes it clear that we should choose for children as we would choose for ourselves in the original position, with no particular conception of the good (such as that held by Jehovah’s Witnesses).


Shaw DM, Busch J. Rawls and religious paternalism. J Med Phil 2012 Aug;37(4):373-386.

Catholicism, Cooperation and Contraception

Patrick C Beeman

National Catholic Bioethics Quarterly
National Catholic Bioethics Quarterly

Abstract
Catholic physicians practice in a world that condones the use of contraception. In the effort to be morally consistent, questions arise regarding the extent to which one’s participation in the provision of contraceptives constitutes immoral cooperation in evil. Particular challenges face the resident physician, who practices under another physician and within the constraints of local and specialty-wide training requirements. We examine the nature of the moral act of “referring” for contraception and argue that, in limited cases,there is a moral distinction between a referral and an intra-residency patient transfer, and the latter may be morally licit according to the principle of material cooperation


Beeman PC. Catholicism, Cooperation and Contraception. National Catholic Bioethics Quarterly. 2012;Summer):1-27.

The physician’s right of refusal: What are the limits?

Robert D Orr

Christian Bioethics
Christian Bioethics

Abstract
A physician’s long-established right to refuse to provide a requested service based on his or her moral beliefs is being challenged. Some authors suggest that physicians should not be licensed if they are unwilling to provide all legal services. Others would grant them the right to refuse, but require them to refer to a willing professional. What are the limits of a physician’s right to refuse? When such a right is claimed on moral grounds, what residual obligations does the physician have to the patient? How should the profession (or society) decide when a moral claim to a right to refuse is justified?


Orr RD. The physician’s right of refusal: What are the limits? Christ Bioet. 2012;18(1):30-40.

Conscience clauses, the refusal to treat, and civil disobedience-practicing medicine as a Christian in a hostile secular moral space

Mark J Cherry

Christian Bioethics
Christian Bioethics

Extract
Jürgen Habermas’s recent observations regarding the increasing gulf between traditional religions and contemporary secularism is correct (2002, 2008). The dominant bioethical and political ideologies of the contemporary Western world have come to be not merely secular but often passionately atheistic. Throughout Western Europe and North America, for example, there is a growing movement to undermine the salience of religious discourse, to undue its influence in the public forum, and to erase religion from the public space. Attempts to frame all of medicine within a completely secular morality, relegating religious belief and practice to the realm of private personal choice, have become ever more prominent. Here, one need only consider the current clash between the US Roman Catholic bishops and President Obama’s administration over whether Catholic employers, such as Catholic hospital systems, ought to be legally required to provide insurance coverage for artificial contraception, including abortifacients, in their employer sponsored health care plan.1 In law and public policy, there has been a profound rupture from Traditional Christianity, which secular proponents aggressively seek to place in the distant past, as if Christianity had been an unfortunate, perhaps immoral, accident of history. Habermas’s acknowledgment of the vast divide between traditional religions that approach the world and moral analysis with knowledge of a God Who commands, and secular worldviews that begin all epistemic and normative analysis with the prior assumption that God does not exist, elucidates the fundamental debates of contemporary bioethics.


Cherry MJ. Conscience clauses, the refusal to treat, and civil disobedience-practicing medicine as a Christian in a hostile secular moral space. Christ Bioet. 2012 Apr 01;18(1):1-14.

Discovery and revelation: The consciences of Christians, public policy, and bioethics debate

Grattan T Brown

Christian Bioethics
Christian Bioethics

Abstract
Health care begins as an act of conscience, which urges a response to the sick and holds caregivers accountable to moral standards that public authorities ultimately do not define. Conscience nonetheless expresses itself as a type of dialogue within oneself that is influenced by dialogue with others, especially with society in the form of civil law and professional standards. A well-formed conscience for health care relates the foundations of morality to health care practices and contributes sound moral judgment about them to the common good. Some current health care policies and medical education presume a distorted view of conscience as personal sentiment. These policies circumvent serious discussion and possible resolution of society’s most vexing bioethics controversies.


Brown GT. Discovery and revelation: The consciences of Christians, public policy, and bioethics debate. Christ Bioet. 2012;18(1):41-58.

Equality, Freedom & Religion

Equality, Freedom & Religion

Roger Trigg. Equality, Freedom & Religion. Oxford: University Press; 2012 Jan 13, 224 pp. ISBN- 9780199576852.

Publisher’s Description
Is religious freedom being curtailed in pursuit of equality, and the outlawing of discrimination? Is enough effort made to accommodate those motivated by a religious conscience? All rights matter but at times the right to put religious beliefs into practice increasingly takes second place in the law of different countries to the pursuit of other social priorities. The right to freedom of belief and to manifest belief is written into all human rights charters. In the United States religious freedom is sometimes seen as ‘the first freedom’. Yet increasingly in many jurisdictions in Europe and North America, religious freedom can all too easily be ‘trumped’ by other rights.

Roger Trigg looks at the assumptions that lie behind the subordination of religious liberty to other social concerns, especially the pursuit of equality. He gives examples from different Western countries of a steady erosion of freedom of religion. The protection of freedom of worship is often seen as sufficient, and religious practices are separated from the beliefs which inspire them. So far from religion in general, and Christianity in particular, providing a foundation for our beliefs in human dignity and human rights, religion is all too often seen as threat and a source of conflict, to be controlled at all costs. The challenge is whether any freedom can preserved for long, if the basic human right to freedom of religious belief and practice is dismissed as of little account, with no attempt to provide any reasonable accommodation. Given the central role of religion in human life, unnecessary limitations on its expression are attacks on human freedom itself.