NASHVILLE, Tenn. — The federal contraception mandate has sparked a debate over the free exercise of religious institutions that refuse to provide such services in their employee health plans. But there is another battle brewing: the fight for the conscience rights of health-care professionals who will be asked to facilitate practices that violate their beliefs.
As both President Barack Obama’s Affordable Care Act and market-driven reforms reconfigure the world of health care, nurses — who are already taking over many duties of family practitioners — will be asked to meet with patients to discuss mandated provisions like Plan B, the so-called “morning-after pill.” With their jobs on the line, will Catholic nurses stand up for their right to opt out of providing services that violate moral norms or will they bow to pressure?
“The right of the Catholic nurse to refuse to provide mandated contraceptive counseling would very likely be upheld” in the courts, said Dominican Brother Ignatius Perkins, the dean of Aquinas College’s School of Nursing in Nashville, Tenn.
“However, if the nurse works in an health agency that provides such services under the Affordable Care Act, she could risk the loss of her job (and the public reasons provided might be embedded in a host of other peripheral reasons rather than the true reason),” Brother Ignatius added. “And I believe this scenario will occur with increasing frequency.”
Brother Ignatius will be a keynote speaker at the National Association of Catholic Nurses’ March 2013 convention, “Catholic Nurses on the Front Lines: Christ’s Ministry in Action.” The event is designed to help Catholic nurses remain true to the spiritual and ethical foundations of their chosen vocation.
“We are trying to help the nurses at the front lines of health care to recommit themselves to the purposes for which the ministry exists,” said Marie Hilliard, the director of bioethics and public policy at the National Catholic Bioethics Center and a board member of the National Association of Catholic Nurses.
From Religious to Lay Nurses
Since the early Church, the suffering of the sick has drawn the compassion and practical assistance of believers, who were inspired by Jesus Christ to care for the whole person and not merely tend to the ailment or disease. The United States became a destination for many European religious orders known for their excellent nursing ministries, and many would establish leading hospitals in the young nation.
In 2012, American Catholics were reminded of that storied legacy when Pope Benedict XVI canonized St. Marianne Cope, the U.S.-born daughter of German immigrants and a Franciscan Sister of Syracuse who helped found two hospitals in New York state before she left in 1883 to care for leprosy patients in Hawaii.
She was an early promoter of handwashing at the order’s nursing facilities, but St. Marianne was not content with containing the spread of leprosy. Amid the desolation of Molokai’s settlements for people with leprosy, she sought to restore the residents’ humanity, dressing them in proper clothes and teaching them vocational skills to stir their creativity.
Today, it is rare to witness women religious performing nursing duties. But U.S. and foreign-born lay nurses have taken their place. And while some serve at Catholic hospitals with a holistic charism, many others work at secular institutions that perform abortions or discourage the provision of hydration and nutrition for patients suffering from terminal conditions.
Enter the National Association of Catholic Nurses, which seeks to revitalize the spiritual roots of the nursing vocation for any nurse — Catholic or not — who is looking for moral and practical support as he or she labors in a health-care system roiled by unprecedented financial, ethical and political changes.
“Nursing was brought to this country by courageous women and men religious as a ministry. It is that essence for nurses that gives even greater purpose and meaning to how we engage in this ministry,” said Hilliard.
“We are hoping to reanimate our association’s historical ties to the wonderful health-care ministries of the religious congregations of this country. So many Catholic nurses practice in diverse secular settings without the charisms that support nursing as a ministry. “
The Catholic Viewpoint
Registered nurse Diana Newman, the president-elect of the National Association of Catholic Nurses, said the organization has about 300 members, who are often involved in local Catholic nurses’ guilds throughout the country.
“The guild contributes a Catholic viewpoint to medicine and health care and tries to foster that viewpoint. Sometimes that perspective gets lost,” Newman told the Register.
Nursing, like medicine as a whole, has changed over the past two centuries, and Newman recalled that nurses once were trained through apprenticeships. Nursing pioneer Florence Nightingale subsequently helped to formalize the education of nurses. Throughout this transition and through the first half of the 20th century, the spiritual roots of the nursing vocation remained intact, but they began to fray as legal abortion attacked the natural-law foundations of the medical profession.
Today, a utilitarian cost-benefit analysis is increasingly employed to determine whether a patient’s “quality of life” justifies medical intervention. In the decades ahead, both government-mandated directives and advanced technology will pose further challenges to the traditional relationship between patients and the health-care professionals who guide decisions about their care.
“The Catholic point of view is the primacy and dignity of the person, who is made in the image of God. That teaching predates current nursing science, which sometimes has an antipathy toward religion — they call it ‘religiosity,’” said Newman.
At present, this criticism of Catholic health care is often sparked by the refusal of Church-affiliated hospitals to provide contraception, abortion, surgical sterilization or in vitro fertilization. All of these procedures are rejected as gravely immoral by the Church.
Meanwhile, a registered nurse working at a secular hospital may also receive criticism from her supervisors or peers if she refuses to participate in procedures that violate her moral beliefs.
Newman says that government regulators and health-care administrators should encourage nurses to strengthen, not weaken, the moral deliberations that guide their interactions with patients and families.
“Many want to get rid of the ‘conscience clause,’ which has always been respected in medicine. But conscience issues do not only involve abortion and end-of-life issues. You use your conscience for everything you do to make sure you are truly fulfilling your responsibilities to the patient,” said Newman.
“Nurses have an intimate connection with patients, and there is no one watching the nurse and patient. They need a strong conscience.”
In Need of Support
Alma Abuelouf, the Memphis-based president of the National Association of Catholic Nurses, told the Register that the nurses who attended local affiliates’ retreats and quarterly meetings know that they are not alone.
“We are all supporting each other spiritually, with continuing education and several partial scholarships for nursing students,” she said, noting that the national organization draws a diverse membership that includes many Hispanic and Filipino nurses.
At present, Abuelouf is the director for the Diocese of Memphis’ department of pastoral services, and that role has given her a broader perspective on the changing face of health care.
“We used to have Catholic hospitals in Memphis, but not now,” she said. “Nurses have to cling to their faith without a Catholic institutional framework.”
Indeed, Brother Ignatius at Aquinas College points out that Catholic nurses are obliged not only to defend their own conscience rights; they are asked to defend the inviolable dignity of every patient as much of modern health care drifts further away from its spiritual foundations.
“As the Affordable Care Act and its regulations unfold, we can look to the work of the Independent Payment Advisory Board, which will decide, based on cost per illness/treatment and a host of other yet unknown variables, who gets treatment and who is denied treatment,” said Brother Ignatius.
“This process demolishes the role of the clinician as healer and emphasizes the role of a technician. So now we have financial algorithms and other ethically neutral strategies, not clinicians as advocates for the sick, the dying, the marginalized, the unwanted and unloved in our midst, determining who should live and who will be left out in the cold,” he added.
“Informed Catholic clinicians (nurses, physicians, etc.) who continue to hold the trust of the sick can lead the way to the formation and implementation of a renewed moral and ethical framework that will interrupt the erosion of human dignity and freedom,” Brother Ignatius emphasized. “That affects all of us.”
Joan Frawley Desmond is the Register’s senior editor.