The threats against religious freedom in the United States have become so acute that five major Catholic organizations have formed the Catholic Health Care Leadership Alliance (CHCLA), a nonprofit coalition dedicated to defending the right of Catholic hospitals, nursing homes, and other institutions—as well as Catholic doctors, nurses, and pharmacists—to provide care and treatment in accordance with the moral precepts of the Catholic Church. The primary mission of the CHCLA will be to act as a clearinghouse for threats to Catholic healthcare and coordinate an effective response through political and democratic engagement. The CHCLA will also work to evangelize, educate, and provide mutual support for patients and professionals.
CHCLA’s board of directors includes representatives from the Catholic Medical Association, the Catholic Bar Association, the Catholic Benefits Association, the National Catholic Bioethics Center, and the Christ Medicus Foundation. Franciscan Health—a system of twelve Catholic hospitals in Indiana and Illinois—became the first Catholic hospital chain to join the alliance. The CHCLA hopes that Catholic health companies big and small will join to protect the right of Catholics to participate in the healthcare system without violating their faith.
Why now? Medical conscience—that is, the right of medical professionals and healthcare institutions to refuse to provide procedures, such as abortion, that violate their religious or moral beliefs—has been under mounting pressure for more than a decade. But there are strong indications that the Biden administration intends to attack medical conscience rights energetically in the coming months. A document recently came to light in a federal lawsuit that implies the Department of Health and Human Services will soon promulgate a rule requiring all medical institutions, organizations, self-insured employers, and professionals to perform or provide access to abortion, transgender transition procedures, and other interventions that are legal but that violate Catholic moral teaching.
This would not be the first time the government used the administrative state to attack medical conscience rights in healthcare. For example, the Obama administration previously required employers to provide free access to contraception under the Affordable Care Act. But it also allowed a narrow religious exemption, which became the subject of years of litigation and Supreme Court cases under the Religious Freedom Restoration Act.
The Trump administration changed the policy in 2020, but that policy was enjoined by a court at the request of progressive activist groups such as Planned Parenthood, the Human Rights Campaign, and the Southern Poverty Law Center. When the Biden administration took office, it asked for a stay of the litigation until it could promulgate a new rule. When that did not happen in a timely manner, the anti-Trump rule plaintiffs sought to restart the litigation, and the Biden administration all but promised to promulgate a rule very much to the plaintiffs’ liking, attaching a 74-page memo from an advocacy group that, if followed, would amount to a dream list of policies desired by secularist cultural warriors. Only this time, the policy would apply universally—without any religious exemptions or opt-outs allowed.
Moreover, the expected rule would allow patients denied required coverage or procedures to file private discrimination lawsuits, even if the refusals were for religious reasons. This could mean that employers would be legally required to cover abortion in health insurance, Catholic hospitals would be required to sterilize patients, and Catholic doctors would be required to participate in transgender transition procedures—among other coercive potentialities.
That would be an existential threat to Catholic healthcare in the United States. According to Douglas Wilson, CEO of the Catholic Benefits Association and a member of the CHCLA board of directors, Catholic hospitals will be faced “with the choice of complying with the mandates or closing their doors.” To which I would add a potential third option: selling to a secular institution to prevent the community harm caused by closing or violating Catholic doctrine by complying. This fear is not paranoid. California provides the model for anti-Catholic healthcare policies that could soon go national.
First, the California courts and the United States Supreme Court are allowing Minton v. Dignity Health, a discrimination lawsuit against Dignity Health, a Catholic hospital, to proceed to trial. The case involves a patient who sued Dignity Health under California’s anti-discrimination law after the hospital system refused to provide a hysterectomy for the purpose of sex reassignment. There were two bases for Dignity’s refusal. First, the surgery would have removed a healthy uterus. Under Catholic healthcare directives, normal body functions can only be interfered with to treat or prevent pathologies. Second, the surgery would have sterilized the patient. Under Catholic moral teaching, medical acts that result in sterilization can only be performed to treat disease.
These moral principles do not target certain patients but apply to all patients. That didn’t matter to the California courts. Because the anti-discrimination law in question applies generally—and because California does not have a state Religious Freedom Restoration Act—the case will proceed to a jury verdict. If Dignity Health is ordered to pay millions in damages, it could be curtains for the practice of Catholic medicine in California.
Meanwhile, last year, the regents of UC Health (the hospital system run by the University of California) voted to begin breaking the existing affiliation between UC Health and Catholic hospitals if the latter don’t adhere to the “values” of secular institutions. UC Health has a contract with some Catholic hospitals to provide services to patients in areas where there are no UC hospitals. If UC Health carries out its plan, Catholic hospitals will be forced to choose between following Catholic moral teaching or continuing to care for the patients they currently serve.
This much is sure. Religious freedom in the healthcare context is under concerted attack by the political left and liberal politicians. The crisis time for religious pluralism in the United States is fast approaching. The need for an organization like the CHCLA could not be more pressing—or its launch more timely.
Wesley J. Smith is the chairman of the Discovery Institute’s Center on Human Exceptionalism.
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