June 24, 2007

Religious Freedom, Except When Denied

Justin Katz

Raising yet another sticky issue on the Sabbath, I note that Connecticut has decided that Roman Catholic hospitals may not behave as if the Roman Catholic faith is actually, you know, true:

Victim advocates cheered a recent bill requiring all Connecticut hospitals to offer emergency contraception to rape victims, but Roman Catholic leaders see it as the beginning of a new national assault on religious freedom.

The bishops in this heavily Catholic but pro-choice state say the legislation, already signed into law by the Republican governor, could force Connecticut's four Catholic hospitals to perform what they consider chemical abortions.

Perhaps some charitable secularists will allow that Catholics might (kinda-sorta) take the women into account — paying some attention to their souls, as well as their health — but there's certainly a tendency to see the boundaries of religious freedom as ending where it might interfere with the reigning materialist worldview.

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If the Catholic hospitals were to decline to provide emergency contraception on the grounds that they oppose contraception in all forms, I could at least respect their consistency. However, emergency contraception isn't abortion, so...

I won't deny that there is "certainly a tendency to see the boundaries of religious freedom as ending where it might interfere with" health.

Posted by: mrh at June 24, 2007 8:04 PM

Yes, substantive freedoms will crumble in the face of vagaries and unstated assumptions. One could argue just about any boundaries one desires from the declaration that religious freedom ends where "health" begins. Context and circumstances, even an explanation of what counts as "health"? Not necessary, apparently.

Posted by: Justin Katz at June 24, 2007 8:23 PM

Plan B is not an abortion. They specifically say it will not work if you are pregnant.

http://www.go2planb.com/ForConsumers/Index.aspx

However, if the concern is that there may be mission creep down the road, I understand.

Posted by: SusanD at June 24, 2007 8:44 PM

Plan B prevents a fertilized egg from implanting. For those who believe, as the Catholic Church teaches, that life begins at conception, that amounts to the same thing.

Posted by: Justin Katz at June 24, 2007 8:57 PM

Dear Justin,

I love how you pick and choose.

Posted by: Bobby Oliveira at June 24, 2007 9:07 PM

I am Christian, but not Catholic (mainly because I consider the Catholic church to be too liberal on many issues). However, I greatly respect their teachings when it comes to promoting a culture of life.

Plan B is an emergency contraceptive. It is not RU-486 (the so-called "abortion pill"). However, many people (including the Catholic Church) consider pregnancy to begin with the fertilization of the egg.

Although Plan B generally works by preventing fertilization in the first place, in some cases it can keep [an already] fertilized egg from implanting in the uterus. Essentially, the argument is that by preventing the implementation of an already fertilized egg, it therefore constitutes an abortion.

I am strongly pro-life. I believe that every person has worth, and that pre-born children are persons. However, I am also pragmatic, in the sense that I want to initially focus on reducing, if not completely eliminating the physical act of abortion, especially the kinds that shock the conscience, such as partial birth, late term, and surgical abortions. Even though all people are equal, and have individual rights and worth, from a purely practical perspective, the way I tend to think about it, I would start with the older pre-born children and then would work incrementally backwards, in order to really reduce and possibly eliminate the overall incidence of abortion.

Finally, I will also state which should be obvious to any Catholics here -- the Catholic Church does not endorse any synthetic method of birth control. Therefore, from the Catholic perspective, they should be able to refuse Plan B on either count -- that it is a method of birth control and/or that it may induce abortion.

The Catholic Church's right to live out their beliefs trumps the "right" one might have to force it to engage in aiding an act which it deems immoral, if for no other reason that the First Amendment explicitly gives it that freedom (Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof;). If you want to get birth control or have an abortion, you don't have go to a Catholic hospital to do it, nor should you expect them to do something which violates their beliefs. If you get sent there by no fault of your own, you always have the choice to go elsewhere.

Posted by: Will at June 25, 2007 1:17 AM

Justin, please accept a thousand pardons for failing to provide a complete defense of the pro-choice and pro-contraception position in a comment box at 8:00 PM on a Sunday evening.

Plan B prevents a fertilized egg from implanting.

I think you're operating under a misconception here. Everything I've read has indicated that this is just not true. Plan B prevents ovulation, and there's no evidence that it has any significant effect on implantation. See, for instance, here. The strongest credible statement I could find in support of your position was here: "In reality, Plan B is thought to operate in a manner similar to hormonal contraceptives, which can prevent ovulation and possibly render the endometrial environment less habitable for implantation." (Emphasis added. Everything else I've read has simply said that there's no evidence that it does prevent implantation, but that it's not possible to prove that it does not.)

I believe that a Catholic woman has the right to exercise her religious beliefs by declining emergency contraception. I do not believe that the operators of a Catholic hospital have the right to refuse emergency treatment based on their religious beliefs.

Posted by: mrh at June 25, 2007 8:03 AM
I believe that a Catholic woman has the right to exercise her religious beliefs by declining emergency contraception. I do not believe that the operators of a Catholic hospital have the right to refuse emergency treatment based on their religious beliefs.

In other words, make way for the mullahcracy of secularism.

Posted by: smmtheory at June 25, 2007 8:44 AM

>>In other words, make way for the mullahcracy of secularism.

Great line, smmtheory!

Posted by: Tom W at June 25, 2007 10:19 AM

What does that even mean?

Posted by: mrh at June 25, 2007 11:06 AM

Will wrote: "The Catholic Church's right to live out their beliefs trumps the "right" one might have to force it to engage in aiding an act which it deems immoral, if for no other reason that the First Amendment explicitly gives it that freedom (Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof;). If you want to get birth control or have an abortion, you don't have go to a Catholic hospital to do it, nor should you expect them to do something which violates their beliefs. If you get sent there by no fault of your own, you always have the choice to go elsewhere."

To me, this is more of a government intrusion issue than it is about ‘abortion’. What business is it of the government if and when a contraceptive is provided to a rape victim?

What Will wrote above is absolutely correct. This a hospital run by the Catholic Church. It has the right to provide medicine and health care within their beliefs. They are not denying health care and there are other health care providers.

I’d feel the same way in being against a law which prevented any hospital from prescribing or providing Plan B in these cases. There is a legitimate debate as to whether Plan B is a form of ‘abortion’. If and when abortion becomes illegal in every case, this scenario will need to be addressed.

But to me, this is another example of the hypocrisy in the application of ‘separation of Church and state’. A prayer said at a public event is the intrusion of religion into the public arena and a crack in the wall of separation. But the state telling a religious based service provider that they have to provide a service which goes against their beliefs is somehow not the intrusion of the state into the private arena.

Finally, did I miss something in that victims of crime have a need for advocacy? Maybe they do.

Posted by: msteven at June 25, 2007 4:48 PM

If it were a Muslim hospital the government would be telling us that we can't demand that it provide contraceptives, or anything else that offends their religious sensibilities, much less religious doctrine!

Posted by: Tom W at June 25, 2007 6:10 PM

Re: my misconception.

Plan B contains an extra heavy dosage of levonorgestrel, which is a progestin, one of the functions of which is to thicken "the cervical mucus, making it more difficult for sperm to pass through the cervix. It also makes the lining of the uterus less receptive to the implantation of a fertilized egg."

No doubt marketing tests would show that emphasizing this fact would decrease customer interest.

Posted by: Justin Katz at June 25, 2007 9:38 PM

Justin,

That's really interesting. That's the first site I've seen that describes that effect of progesterone; everything else I've ever read has emphasized its role in preventing ovulation, and hasn't mentioned the uterine lining. Off to do some research...

First thing I found was this, which, interestingly enough, says that progestins "have also been used to treat habitual miscarriages due to progesterone's role in sustaining pregnancy."

This site says: "Levonorgestrel is used to prevent pregnancy by inhibiting ovulation (the release of an egg from an ovary) and by causing the cervical mucous to thicken, which makes it harder for sperm to move toward the uterus."

(The official Plan B site does indicate that it's possible that Plan B inhibits implantation, but I believe this is still unproved. I should say that this is more or less academic for me, since I support the use of Plan B regardless of its mechanism, but I know it matters for some people. I stand by my statement that, whether or not it inhibits implantation, emergency contraception isn't abortion.)

Posted by: mrh at June 25, 2007 10:03 PM

Follow up: I've read about 15 pages now on levonorgestrel, and haven't found any source other than the one you cited that didn't qualify the possible implantation-inhibiting effect on the endometrium with "possibly" or "theoretically." Weird.

Posted by: mrh at June 25, 2007 10:16 PM

I don't find it that weird. Plan B is getting through doors that were closed to RU-486, and some of those might shut on the grounds that preventing implantation is abortion. It seems I had more luck finding material when I read up on Plan B a couple of years ago, but some interesting points:

Progestin-only contraceptives, of which levonorgestrel is a hyped-up version, do affect the lining of the uterus.

In normal biological functioning, progesterone (aka progestin, for our purposes) "prepares the lining (endometrium) of the uterus (the womb) to receive and sustain the fertilized egg and so permits pregnancy." That fits the puzzle because a thin mucus could do what it has to do to the uterine wall without affecting the fertilized egg, while a thick mucus would act as a barrier.

It also makes sense that progestin-only contraceptives do not prevent ectopic pregnancy, because (I'd imagine) once the egg is fertilized, if it is going to implant somewhere that the mucus isn't flowing, the drug has no further defenses.

Posted by: Justin Katz at June 25, 2007 10:36 PM

Well, I'm well outside my area of expertise. I'm still struck that your cite was the only one that didn't use a qualifier like "possibly."

preventing implantation is abortion

Only under an idiosyncratically expanded definition of abortion, though, right? Abortion is the intentional termination of a pregnancy, and medically speaking, I thought a woman can't be said to be pregnant until the fertilized egg implants.

Posted by: mrh at June 25, 2007 11:05 PM
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