An Answer for ProfMTH

Hi Mitch,

Can't do this as a video response at the moment, so please take this as a draft of the script I would have used:

You ask in your video "Catholics, Contraception, and Conscience (Some Questions)" whether four hypothetical religious conscience objections are similar to the "religious liberty" objection to the HHS rule regarding the mandatory provision of contraceptive coverage by all employers (since revised to shift the requirement to insurers rather than the employers themselves).

The four examples you posit are:

Muslim women objecting to a prohibition on full or substantial facial coverings in public;

Santeria churches objecting to a prohibition against the slaughter of animals for a purpose other than that of food production;

Jehovah's Witnesses objecting to the prohibition of the offering for sale of periodicals by persons under the age of 14;

Native Americans' objection to the prohibition of ANY use of peyote, currently classified as a Class I controlled dangerous substance, in spite of their ritual use of it in certain religious ceremonies.

I see two reasonable distinctions between the contraception ruling and the four you cite: medical necessity, and the definition of contraception itself.

I will begin with the latter: the fact that a medical preparation or device results in the partial or complete inability of a woman to get pregnant, either through chemical or mechanical means, does not warrant the conclusion that its only purpose is that of contraception.

For example, various hormonal therapies have what could be termed a "contraceptive side effect" in that the alteration of hormonal balances can often result in lack of ovulation, an inhospitable environment for implantation, or "weakened" eggs that might be incapable of being fertilized. Is every hormonal therapy therefore a form of contraception? Was the prescription written in order to act as a contraceptive? The regulation of a woman's muenstral cycle, or the use of hormone therapy following certain surgeries are perfectly reasonable and recognized medically necessary applications of said therapies. The fact that they have a "contraceptive side effect" does not, de facto, make them contraceptives. Similarly, while cancer patients undergoing chemotherapy often lose a great deal of weight and hair, this does not, de facto, cause us to think of it primarily as a weight-loss or depilatory therapy.

Thus, for me, the issue is one of medical necessity, not side effects. In consultation with her doctor, a woman may have any number of choices of therapies for any number of medical conditions. A drug such as Accutane (indicated for the treatment of acute acne) has recognized, substantial contraceptive side effects, the packaging itself contains a huge number of warnings, a female patient must fill out all sorts of releases and acknowledgements, and is advised in the strongest terms not to get pregnant during a course of Accutane therapy. See, for example, the iPledge Program.

Is this treatment of acne, therefore, a form of contraception? Scientifically speaking, I cannot deny that it is; nonetheless, in terms of medical necessity and legality, I see no legal or moral roadblock to using Accutane in consultation with one's physician, in spite of its potential to devastate a pregnancy. Yes, it is often covered by insurance.

Medical necessity is a matter for the woman and her doctor to determine. A responsible physician will frequently recommend birth control to a woman who has a history of difficult pregnancies and who does not wish to subject either herself or a future fetus to the agonies and risks that, for whatever genetic reasons, pregnancy would impose.

A sexually active woman who is not prepared to have children, or who wishes to wait, or who is in an occupation where a pregnancy may compromise the safety of the people around her (say, a woman in the military), would be perfectly within her rights to seek out an appropriate form of birth control. The exact form would of course be based on her medical history, family history, and lifestyle. Isn't this what we have doctor-patient privilege for? It is for those two people to consult, review the situation, and settle on the appropriate approach.

If she works at a Catholic university, I don't see any reason why the revised HHS rule shouldn't be adequate. Her friend who works across the street at a law office could theoretically be covered by exactly the same insurance program. If their medical cases were similar, they would receive similar advice from their doctors in spite of the religious views of either employer.

In the same way that I don't tell my employers whether I am on a medically necessary therapy, since it has no effect on my productivity... it is also none of their business. It is between my doctor and myself.

These two issues, to me, distinguish the contraception ruling from the four hypotheticals you cite. I refrain from commenting on them directly beyond pointing out that none of the four are behaviors with recognized scientific or medical merit; those four groups are enjoined to act in those ways for reasons of faith, not medicine. Lumping them together with the contraception ruling reminds me of the fundamental error that Lee Doren made in his contraception video in which he says that, because condoms are a form of contraception, everyone in America therefore already has access to contraception, so the ruling itself is pointless.

We can already see that the Catholics themselves are divided: for example, the Catholic Health Association is fine with the revision, but the more doctrinal Conference of Catholic Bishops is not. Furthermore, this has been tested at the state level several times and has failed (see the Catholic Charities et al cases in California and New York). Over two dozen states currently have such conscience clauses on the books, and things seem to be working out reasonably well. It certainly hasn't affected the number of Catholics who actively use contraception, and that is probably the most embarrassing thing for Rome at the moment.

Lastly, please keep in mind that the ruling requires access to birth control--it doesn't mandate that anyone use it. This is in stark contrast to your four examples, each of which stems from a religious/faith-based mandate.

I look forward to your feedback. Thank you for the video, and take care!