By: Maureen Kramlich, Esq.

Mother Frances Cabrini. Mother Theodore Guerin. Mother Mary Russell. Mother Xavier. Mother Joseph. The legacy of these pioneering founders of U.S. hospitals and Catholic health care systems is now under attack. Their names are familiar to all: Sisters of Providence, Sisters of Charity, Sisters of Mercy, the Franciscan Sisters of Mary, Sisters of the Holy Cross. These are a few of the religious communities renowned for founding and operating hospitals throughout the United States—generally in cities and towns where none existed, certainly none to serve the poor.

What does it mean to be a Catholic hospital? One hospital's website answers this question well:

St. Vincent Charity Hospital is a special place to receive healthcare, with the finest medical programs and most advanced treatments. It is also a Catholic hospital, which means that our Caregivers are dedicated not only to caring for the body, but also for the mind and the soul. This is a place where compassion is more than just a word - it is a vision. Inspired by the healing mission of Jesus, our Caregivers strive to treat all people with respect, dignity and care. To provide faith-based health care that marries human compassion with state-of-the-art technology and services. ...

This ministry was established for the purpose of serving those at the margins—the poor, especially women and children among the poor. The quality of health care was superb from the start: In the 1940s, the premier polio treatment center in the Midwest was developed by the Franciscan Sisters at St. Anthony's Hospital in St. Louis. The Sisters of Charity who founded St. Vincent's Hospital in New York City have provided excellent emergency care across two centuries, caring for victims from the Titanic in 1912 to the victims of the September 11th terrorist attack in 2001.

Catholic hospitals treat 80 million patients each year and make up 11% of all community hospitals. As abortion advocates are quick to point out, Catholic hospitals are often the only hospitals in rural communities. This is so because they operate not out of a profit motive but out of charity. In 1998, for example, the nation's 637 Catholic hospitals' service to the poor resulted in a $2.8 billion financial loss. On average, Catholic hospitals provide a wider range of services than other hospitals: nutrition programs, natural family planning classes, geriatric services and HIV/AIDS treatment.

Today this legacy and this mission are being undermined by abortion advocates. For decades they have attempted to force Catholic hospitals to provide abortions or go out of business. In recent years their tactics have become more subtle, and the campaign to deny Catholic health care providers their rights of conscience has met with some success.

History of Efforts to Deny Conscience Protections

Shortly after the Supreme Court handed down its 1973 decision in Roe v. Wade, Congress took the important and necessary step of passing a law to protect health professionals and hospitals with conscientious objections to abortion. The law declares that the receipt of federal funds in various health programs will not require hospitals to participate in abortion and sterilization procedures. It also forbids hospitals in these programs to make willingness or unwillingness to perform these procedures a condition of employment. The law was partly in response to a federal district court decision seeking to require a Catholic hospital to perform sterilizations. It also responded to the concern that some would misinterpret Roe as establishing an entitlement to abortion, as opposed to a right to be free from government interference in the abortion decision. In fact, in a 1975 law review article, Planned Parenthood general counsel Harriet Pilpel set out a litigation strategy for challenging conscience protections on the basis that they restrict the "right" to abortion.

The states also responded swiftly to this threat. The year after Roe, twenty-seven states enacted laws protecting health care providers from being forced to participate in abortions. Two years later, five more states passed conscience protections. Today forty-five states have laws protecting health care providers who conscientiously object to participating in abortion. Some states also protect providers who object to other kinds of procedures, such as euthanasia, sterilization, artificial insemination, abortifacient drugs and contraception. Federal law also protects health care providers who object to participating in federal executions. It is therefore clear that the principle of the right of conscientious objection is well recognized—but it is also increasingly under attack.

Almost thirty years after Roe, the goal of abortion activists remains the same. The website of the Maryland NARAL (National Abortion and Reproductive Rights Action League) Hospital Provider Project does not mince words: "The goal of the Hospital Provider Project is to increase access to abortion services by requiring Maryland hospitals to provide abortion and other reproductive health care" (emphasis added). Similarly, a recent report by the American Civil Liberties Union (ACLU) titled, "Religious Refusals and Reproductive Rights," aims at requiring all hospitals, including Catholic hospitals, to provide abortions. The report asserts that because Catholic hospitals are involved in delivering a public good—health care—"they should play by public rules." Not coincidentally, "public rules" are ACLU rules: "the more public and secular the setting, the less acceptable any institution's claimed right to refuse."

This bold rhetoric is often accompanied by audacious attempts (and occasional successes) at mandating abortion. In 1997, a coalition of abortion rights activists in Alaska brought a lawsuit to compel a private non-sectarian hospital to perform abortions. The Alaska Supreme Court ordered the hospital to do so, holding that the hospital's pro-life policy "is an unconstitutional restriction on the right to abortion." At an American Medical Association House of Delegates meeting in 2000, the California Medical Association tried to win AMA endorsement for legislation requiring all hospitals to provide a "full range of reproductive services," including abortion. Fortunately, the resolution was defeated after an intense debate. And just last winter, the newly elected mayor of New York City, Michael Bloomberg, acted on his campaign promise to mandate abortion training in all the city's obstetrics and gynecology residency programs.

New Threats

Today abortion rights activists are implementing a subtle and incremental strategy to undo conscience rights. For example, they have embarked on a campaign to mandate the coverage of contraception in all employer benefit plans for prescription drugs claiming that contraceptives are "basic health care."

A number of states have adopted contraceptive mandates, most with inadequate protection of conscience or none at all. Virtually all these mandates require coverage of so-called "emergency contraception." This drug preparation is misnamed because it commonly operates by interfering with implantation in the womb six to seven days after conception, thus causing the death of the early human embryo. Efforts to mandate "contraceptive" coverage are therefore attempts to obscure or destroy the line between abortion and contraception, and to universalize coverage of abortifacient drugs at the expense of conscience rights.

Abortion rights advocates have also made some attempts to mandate the routine provision of "emergency contraception" to rape victims. Catholic teaching supports offering these drugs to rape victims when it is clear that the treatment would have a contraceptive rather than abortifacient effect. Although only a few state legislatures are considering "emergency contraception" mandates, an organized national effort—the Abortion Access Project—which is trying to garner support for them is now operating in twenty-four states. It is clear from the project's materials, including fact sheets and resources on its website, that it has targeted Catholic hospitals. Mandating abortifacient drugs is therefore an incremental step towards requiring even Catholic hospitals to perform abortions. Indeed, the group's materials on "emergency contraception" are included in a kit titled: "Designing A Campaign To Increase Hospital-based Abortion Services" (emphasis added).

Abortion activists have also enlisted the support of state and local governments in discriminating against pro-life health care providers. They have intervened in "certificate of need" proceedings to defeat health care facilities that object to abortion. They have engaged state attorneys general to apply novel theories of law to prevent mergers involving hospitals with pro-life policies. And they have sought to end public financing of Catholic hospitals.

These sophisticated legislative and litigation strategies have been developed to abolish conscience rights for one primary reason: Abortion advocates are desperate to legitimize abortion, which still carries a stigma in the medical profession and in society at large. Half of Americans consider abortion murder. Fewer than a thousand physicians perform them. Only 7% of abortions are performed in hospitals, and they are performed in just 14% of all hospitals. But if abortions had to be provided in all hospitals as a matter of law, this would create the impression that they are basic, standard health care. In 1995, when he called for intensified efforts to require abortion training for all medical residents, abortionist Dr. David Grimes declared that "making abortion training a routine part of any residency. . .will put abortion back in the mainstream of medicine." (Of course, it has never been in the mainstream.)

Aggressive attempts to undermine conscience rights can also be explained by the fiercely competitive and commercial nature of the abortion business. To generate the most business, abortion clinics have located almost exclusively in urban areas, where there is a large population base. "Abortion clinics are no different from other specialty services, said Dr. William Ramos, who runs an abortion clinic in Las Vegas. 'In the entire state of Nevada, there is only one Lexus dealer and only one Acura dealer', he said." With abortion, Dr. Ramos continued, "there is less work and more income." However, "[c]linic owners say they have little choice but to cluster in cities—that is the only way they can find enough patients."

As public sentiment against abortion has grown in recent years, and fewer women seek abortions, clinic owners have become even more protective of the "business" they already have—and less willing to extend their reach to rural areas where even fewer women seek abortion. Rather than "setting up shop" in such areas at a risk to their profit margin, they are advocating that all hospitals, including Catholic hospitals, be required to perform abortions.

Should pro-abortion forces succeed, they will be responsible for shutting down the Catholic health care ministry. As Cardinal George so movingly testified against the AMA proposal to requiring all hospitals to provide all "reproductive health services": "Catholic hospitals cannot comply. Effectively, the American Medical Association is being asked to help abolish Catholic health care in this country."

To counteract such efforts, existing conscience protections must be strengthened. Because attempts to undermine conscience rights are advancing as mandates for other procedures such as contraception and "emergency contraception," comprehensive conscience laws are needed to protect health plans and hospitals from being forced to pay for and participate in these procedures. The laws should be comprehensive also in terms of protecting the full range of health care providers: hospitals, physicians, nurses, nursing students, medical students, and nurses' aides.

Defending such rights is not just a Catholic issue. It is a fundamental human right to refuse to take part in morally evil actions:

To refuse to take part in committing an injustice is not only a moral duty; it is also a basic human right. Were this not so, the human person would be forced to perform an action intrinsically incompatible with human dignity, and in this way human freedom itself, the authentic meaning and purpose of which are found in its orientation to the true and the good, would be radically compromised. What is at stake therefore is an essential right which, precisely as such, should be acknowledged and protected by civil law. In this sense, the opportunity to refuse to take part in the phases of consultation, preparation and execution of these acts against life should be guaranteed to physicians, health-care personnel, and directors of hospitals, clinics and convalescent facilities. Those who have recourse to conscientious objection must be protected not only from legal penalties but also from any negative effects on the legal, disciplinary, financial and professional plane.

(Pope John Paul II, The Gospel of Life, no. 74)

What should be done to protect the right of conscience? Catholics must campaign in support of conscience rights on the state, local and federal levels. We should support community hospitals and health centers with pro-life policies. We should lobby on behalf of stronger state and federal conscience laws, and write letters to our state and federal representatives opposing contraceptive and "emergency contraception" mandates.

While calling themselves "pro-choice," abortion advocates have as one of their top priorities the destruction of free choice on abortion and other morally objectionable procedures. They want not a diverse and pluralistic health care system, but a system that is unanimous in furthering the destruction of life as a basic aspect of health care. Real freedom and pluralism, as well as the sanctity of human life, will be among the casualties if they succeed.

Maureen Kramlich, Esq. is public policy analyst, U.S. Conference of Catholic Bishops' Secretariat for Pro-Life Activities.