Blog by-the-Sea

Cardinal Rigali's Letter to Congress on Health Care Reform and Abortion

The USCCB website yesterday posted an article on Cardinal Rigali's letter to the House of Representatives.  The full text of that letter, dated August 11, 2009, is downloadable from that page.  The Catholic News Agency also has an article about the letter.

He affirmed that the U.S. Conference of Catholic Bishops has "long supported health care reform that respects human life and dignity from conception to natural death; provides access to quality health care for all, with a special concern for immigrants and the poor; preserves pluralism, with respect for rights of conscience; and restrains costs while sharing them equitably."  At the same time, he returned to the theme of letters previously sent by other U.S. bishops, encouraging the Congress to "respect human life and rights of conscience in the context of abortion" in its health care reform legislation.

Cardinal Rigali's letter specifically mentions some of the provisions of the bill that are supportive of life and that protect conscience rights of those who oppose abortion.  He also points out two specific areas in which the existing bill before the House of Representatives (H.R. 3200, as amended on July 31, 2009) remains deficient.  Among these is a remaining potential that abortion will be designated as a mandated benefit in the federal health insurance plan, and the bypassing of the Hyde Amendment that has long prevented federal funding of health benefit packages that cover abortion.

Limited Health Care for the Poor; Unlimited Abortions for All?

The more I hear about the details of the proposed health care plan, the worse it sounds.  I posted something earlier supporting the USCCB's position in favor of a national health care plan, with the provision that it must support life.  For clarity, I have to point out the obvious: The pending bill for a national health care plan is increasingly inconsistent with what the USCCB said it would support, and increasingly inconsistent with what I said I could support.

I received this today from our Sen Feinstein:"I understand your opinion that private coverage of abortion services should be restricted in health reform. However, I believe that reproductive health services should be treated no differently than [sic] any other health care service."

Limited health care for the sick who are too poor to pay for it, and unlimited elective abortion for all, IS treating abortion differently from other health care service, isn't it?

On July 30, the USCCB released a Statement regarding Cardinal Rigali's letter to the members of the House Energy and Commerce Committee "urging them to amend “America’s Affordable Health Choices Act' (H.R. 3200) to retain longstanding government policies on abortion and conscience rights."  The Statement goes on to mention that earlier Statement that supported national health care with pro-life provisions:

"Cardinal Rigali reiterated criteria for 'genuine health care reform' set forth by Bishop William Murphy, Chairman of the bishops’ Committee on Domestic Policy, in his letter to Congress on July 17.  He described health care as 'a basic right belonging to all human beings, from conception to natural death' and said that 'the United States Conference of Catholic Bishops is working to ensure that needed health reform is not undermined by abandoning longstanding and widely supported policies against abortion funding and mandates and in favor of conscience protection.'"

The more I know about the health care bill now before the U.S. Congress, the more disgusted I become.  Our Congress has before it a chance to meet the needs of many Americans who are greatly in need of health care, who do not qualify for existing Medicaid coverage, or who cannot find quality physicians still willing to accept it.  Instead of correcting the deficiency in providing basic healthcare for those who do not have insurance, the plan under consideration increasingly sounds like it offers health care that is very limited in its provision for the poor and the elderly who are sick,  and that is unlimited in its provision of elective abortion for all. 

Somehow, Pinto health care for the sick, and Cadillac elective abortion, sounds to me more and more like the pro-abortion lobby has taken complete control of the thing.  Instead of caring for the poor and the elderly, our Congress is sacrificing the poor to come up with more money to make the pro-abortion lobby happy. 

It sounds more immoral all the time.

Pro Life and Pro Healthcare Reform

The USCCB, through Bishop William F. Murphy, placed a statement on the Congressional Record on May 20 at a formal round table discussion on "Expanding Health Care Coverage."  The staatement is both pro life and pro healthcare reform.  Catholic Online has the text and commentary, saying that it "presumes political realities" and that we must stand with our bishops and raise our voices loudly, as they are "our champions in this battle for Life over death".

The USCCB statement says, among other things:

"The basic assumptions we offer are these: 1) a truly universal health policy with respect for human life and dignity; 2) access for all with a special concern for the poor; 3) pursuing the common good and preserving pluralism, including freedom of conscience and variety of options; and 4) restraining costs and applying them equitably across the spectrum of payers."

The statement is also available for download on the USCCB page on Justice, Peace and Human Development.

This is something I have been meaning to write about when I have had the time to do more calm and reasoned research and reflection.  So I suppose I will have more to say later.

I think it would be inconsistent to be pro-life for the unborn, the disabled, and those facing end-of-life decisions, while opposing healthcare reform when the number of uninsured in the U.S. is now estimated at 47 million people and rising. 

I was glad to see Bishop Murphy's statement because "pro-life" has become such a championed cause of the Republican Party (at least in past years) while healthcare reform is currently seen as a championed cause of the Democrats.  I have wanted to stick my neck out and agree with a liberal commenter elsewhere who meant to challenge a pro-life commenter by saying that you cannot be both pro-life and anti-healthcare reform. 

Frankly, it puts us in a bit of a bind because the Republican Party, which has been our political supporter on abortion, has tended to view healthcare reform as a free enterprise issue and thus oppose a national healthcare plan, even one in competition with the for-profit health insurers.   I don't think healthcare is rightly viewed as a free enterprise vs. socialism issue.  Historically, U.S. health care, including U.S. health insurance, has been largely provided by not-for-profit organizations, and not by businesses. 

In California, historically, two primary choices were Kaiser Permanente (which is still non-profit), which was an HMO before HMO's became fashionable, and Blue Cross (which used to be non-profit).  Our hospitals still include a large number of non-profit hospitals, including our University of California healthcare systems (owned by the state-run U.C. medical schools -- and yes, I actually donate a little bit more than I pay in bills to a government-owned healthcare system, and it is probably the highest quality healthcare system in our state); Catholic hospitals; various associations of non-profit hospitals such as Sutter Healthcare in the Bay Area; and regional public "district hospitals". 

So, personally, the idea of championing "free enterprise" in treating healthcare coverage as a for-profit business does not ring any liberty bells with me.  Nor do I believe that a government health plan for the poor and the uninsured middle class will cause the quality of healthcare to drop.

I suppose that, once I have a better idea of how to write about an emotional issue in a way that is appropriate to this blog, I will need a category for it.  The existing categories on abortion, freedom of conscience, and human rights have overlapped more than I thought they would.  I will probably change the name of one of those to "healthcare" and reorganize a bit within those categories rather than adding a new one.

Meanwhile, thank you bishops!  I think Bishop Murphy's call was a good one, and it makes me feel more comfortable saying here that I am pro-life and pro-healthcare reform, and I think it is a consistent position on the issues.

Center for Disease Control Video on Hand Sanitation to Avoid Illness

Pro-Life Action and Prayer Now

1. Join the E-Mail Campaign against FOCA. The U.S. Conference of Catholic Bishops is encouraging people to join an e-mail postcard campaign against FOCA.  To send the e-mail to your Congressional Representatives,  fill out the form, and the National Committee for a Human Life Amendment will send it to your congressional representatives for you.

2. Write to the U.S. Department of Health and Human Services (e-mail to proposedrescission@hhs.gov) and to the president opposing their plan to rescind the regulation protecting health care professionals from being required to perform and advise medical procedures in violation of conscience.  Contrary to reports, the regulation was not rushed through by the Bush administration at the last minute.  Rather, it was proposed last August in order to "increase awareness of, and compliance with, three separate laws protecting federally funded health care providers’ right of conscience" (as stated by HHS at that time).  The regulation was issued because of widespread pressure on health care practitioners despite those laws.  The HHS proposal to rescind the regulation was published today.  You can read it here or Download the Federal Register notice here.  There is a mandatory 30 day period for public comment, starting today.  The purpose of the regulation is explained here.  A letter from 35 U.S. senators was reportedly sent to the President today opposing the plan to rescind this regulation.  Consider using that letter as a form to prepare your own e-mails to the president and HHS opposing the rescission of that regulation.

3.  Taking action works.  Consider, for example, the Connecticut bill pulled today in response to public outcry, especially by Catholic parishioners concerned about the proposed bill that would have purported to change the way churches were allowed to govern themselves in the State of Connecticut.  Recognizing the bill's impact on religious freedom, the state legislature pulled it before a scheduled hearing.  See articles in The Deacon's Bench and Insight Scoop.  

4.  Pray.  The Dominican nuns at Moniales today wrote about the Connecticut bill just mentioned, along with other ways in which persecution of Catholics is increasing, and said:  "Many, many, Catholics need to wake up and realize that the freedom to practice our Faith is under attack and make their voices heard. But while this is necessary we also need to remember that at root this is a fight "against principalities and powers" (Ephesians 6, 12) and prayer and penance are ultimately the only answer. This is why the contemplative vocation is needed more than ever!"

Pending Case about Doctors' Religious Freedom

A case called North Coast Women's Medical Group v. Benitez, now pending before the California Supreme Court, raises a question concerning a medical doctor's right to refuse to perform a medical procedure in violation of their religious beliefs under the First Amendment's freedom of religion.  The California Catholic Daily has an article about "amicus" (friend of the courts) briefs filed in support of the doctors.  The California Courts website provides a list of the briefs filed.

The Court of Appeal previously held that the doctor's could offer evidence that they refused to perform an intrauterine insemination (IUI) on an unmarried patient because their religious beliefs prohibited such a procedure for any married woman.  [You can download the Court of Appeal decision here:  Court of Appeal.PDF]  The patient contends that the doctors refused to perform the procedure because she told them she was a lesbian.  At the time when the doctors refused to perform the procedure, discrimination for sexual orientation was illegal by state statute, and discrimination for marital status was legal.

The issue before the Supreme Court is summarized as follows on the California Courts' website: "Does a physician have a constitutional right to refuse on religious grounds to perform a medical procedure for a patient because of the patient's sexual orientation, or do the provisions of the Unruh Act . . . preclude such discrimination in the provision of services notwithstanding the physician's religious beliefs?"

The Supreme Court has not yet scheduled argument in the case.

More U.K. Doctors Refusing to Perform Abortions

The U.K.'s Royal College of Obstetricians and Gynæcologists ("RCOG") issued a statement yesterday in response to an article published the same day in the Independent titled "Abortion Crisis as Doctors Refuse to Perform Surgery."  The article spoke of an "exodus" of doctors, who in increasing numbers are refusing to perform the procedure.  The reluctance of doctors and nurses to perform abortions has grown in recent years, such that it has become difficult to obtain an abortion through the public health care facilities.  At the same time, the demand for abortions has doubled since the 1970's, to a record high at the present time. The Independent thus stated:

"As a result, after decades of campaigning, anti-abortion organisations may be on the point of achieving their objective by default. Repeated efforts to tighten the law have failed and public opinion remains firmly in support, but the growing number of doctors refusing to do the work means there may soon not be enough prepared to carry out terminations to meet demand."

The RCOG's statement in response to the article affirmed that medical trainees increasingly opt out of training in abortion.  The statement also affirmed a doctor's right to refuse to perform such procedures, but also stated:

"The RCOG recognises that it is an important right for any doctor to object to performing abortion. The future of the sexual healthcare services requires careful workforce planning in order for abortion services to be available to the women who need it most."

How does one do "workforce planning in order for abortion services to be available to the women who need it most"?  Any plan to screen out medical school applicants who object to abortion on moral grounds would clearly violate First Amendment religious freedom in the United States, although that might be viewed differently in the U.K.  Women "who need it most" presumably means women who would have difficulty affording the expense of a private abortion clinic.  Would "workforce planning" mean restricting job opportunities in the public health-care system to doctors and nurses who have no moral objection to performing abortions?  In the U.S., discrimination in hiring based on a doctor's religious beliefs would also violate constitutional protections.

Nonetheless, a recent survey of U.S. doctors showing that 52% of American doctors oppose abortion for failed contraception (discussed in an earlier post) prompted a New York Times article speaking of doctors as failing their patients.  As discussed in the NEJM article that reported the survey results, students drawn to medical school often have strong religious views.

A Zenit article about the situation in the U.K. quotes Julia Millington of the U.K.'s ProLife Alliance, who said of young doctors, "Those choosing to go into medicine presumably do so because they want to cure sickness and disease, not end the lives of innocent human beings." 

The possibility of choosing medical students or hiring doctors for public health facilities based on their willingness to perform abortions raises the prospect of passing over the most qualified medical school applicants and those most likely to be motivated by charitable interest in helping others.  Long term, this would almost surely work contrary to the best interest of the same low income population intended whose interests would appear to be served.

52% of American Doctors Oppose Abortion

A January 13, 2007 editorial in the New York Times is titled "Doctors Who Fail Their Patients."  One might think it would be about American medical doctors with drug addiction problems, doctors who commit insurance fraud, or doctors who treat their patients as billing accounts more than as people.

But that is not what the editorial is about.

Instead, the editorial is a complaint about the doctors who do act on conscience.   The editorial states its complaint as follows:

"Now a new survey . . . by researchers at the University of Chicago, was published last week in The New England Journal of Medicine. The researchers mailed questionnaires to some 2,000 doctors asking whether they had religious or moral objections to three controversial practices. Of the 1,144 who responded, only 17 percent objected to “terminal sedation” to render dying patients unconscious, but 42 percent objected to prescribing birth control for adolescents without parental approval, and 52 percent opposed abortion for failed contraception.

"The encouraging news is that substantial majorities thought that doctors who objected to a practice nevertheless had an obligation to present all options and refer patients to someone who did not object. But that left 8 percent who felt no obligation to present all options and an alarming 18 percent who felt no obligation to refer patients to other doctors. Tens of millions of Americans probably have such doctors and are unaware of their attitudes."

Well, do atheist doctors ever refer Christian, Jewish or Muslim patients to doctors who do object to the procedures that many people of faith do not want?  Do they refer patients of faith to doctors who share the patient's opposition to birth control, for example, or do they, instead, give them a polite (or annoyed) look and a bill?  Whenever I have stated my religious preference in a medical office or hospital, I have never once had a health care office respond that the doctor I was about to see did not share my religion's views on an issue and that they could refer me to someone who did.

The medical journal article mentioned in the editorial is Religious, Conscience and Controversial Clinical Practices, authored by Farr A. Curline, M.D., et al, in the February 8, 2007 issue of the New England Journal of Medicine.  The article actually points out that medical doctors, under the laws of most states, are legally protected in their ability to act on their conscience in refusing to provide such controversial procedures as abortion.  Some of those protections now face challenges from people who do not want doctors to be free to act on conscience in modern medical care.  Of course, those people's concern is that they, as patients, want to have a doctor who will act in accordance with the patient's values.  So do I, and in my case that means I want to have a doctor who has a conscience and will act on it, not a doctor who feels as if he has to deliver a soul-less form of medical care with the exception of that pretense of holistic medicine that throws in a dose of touchy-feeliness with any bad news.
 
But aren't there more important aspects to the information shown in the journal article in question?

For one thing, how do the Portuguese pro-abortion advocates get away with telling the Portuguese people that if they want to be modern, they must legalize abortion for any reason up to 10 weeks of pregnancy when the New England Journal of Medicine shows that 52% of modern U.S. doctors oppose abortion for failed contraception?  Are 52% of American doctors all that backward?

Isn't it more likely the case that if 52% of the people most highly educated in life and death medical issues consider this procedure to be immoral, that society should take take notice, at least to the point of considering that view as a respectable educated opinion on a topic informed by medical expertise?

And do a majority of American doctors hold a somewhat pro-life view because people of faith are more likely to become doctors?  If so, then isn't that too worthy of comment?  If children who grow up in families of faith that hold pro-life views (including many Christian, Jewish and Muslim families), are more likely to become doctors, that presents a powerful message about the stability and motivation of such families.

Of the doctors shown in the survey, 36% were categorized as having  high "intrinsic religiosity".  46% of the surveyed doctors attend religious services twice a month or more, while only 10% never do so.  The breakdown of religious groups was 38% Protestant, 22% Catholic,16% Jewish, 14% other, and 10% none.  In comparison, about 20% of Americans reported that they had no religion, or that they were unwilling to answer a question about what their religion was, in the latest U.S. Census.

Of great importance, the journal article reports that most physicians support a balance  involving both full disclosure and open dialogue with their patients about options, in a manner that respects both the doctor's own values and those of the patient:

"This balance resembles the interactive models proposed by Emanuel and Emanuel, Quill and Brody,  Siegler, and Thomasma.  These ethicists have all recommended models for the doctor–patient relationship that retain the moral agency of both the physician and the patient by encouraging them to engage in a dialogue and negotiate mutually acceptable accommodations that do not require either of the parties to violate their own convictions. . . . [These models] allow physicians to explain the reasons for their objections to the requested procedures."

In addition, the study found that the differences among doctors about whether to refer patients to other doctors who are willing to provide a controversial treatment that they themselves are not willing to provide reflects the disagreement on that same issue within the field of bioethics.

The New York Times editorial, saying that such physicians "fail their patients", does not accurately reflect the journal article in question.  Other issues raised by that article merited more attention, including as the disagreement among physicians of what they can ethically do when handling controversial contemporary issues, and its affirmation that 52% of physicians are pro-life in the case of abortion for contraceptive failure.