Institutional Conscience and Catholic Health Care

Despite serious challenges to the identity of Catholic health institutions in the United States, both Church and society should continue to see them as privileged places of moral discernment. This discernment occurs in “institutional conscience,” namely, a dialogue among all those authorized to act on the institution’s behalf about institutional actions, for example, medical interventions. The institutional conscience of Catholic health institutions should be respected by society at large, leaving them free to practice Christian healing and to show the problems with certain practices that they eject, such as abortion, and to seek alternatives. I WOULD LIKE TO CONSIDER the hopeful, as well as difficult situation of Catholic health institutions today. Although some health care practices present serious challenges to the Catholic identity of these institutions, we should see them as privileged places for moral discernment. The modern health care institution combines a wide range of gifts, specialized knowledge, technical abilities, and moral experience for healing of patients. Healthy institutions provide a structure for professionals to deliberate about actions they perform on the institution’s behalf. One can imagine a sort of daily dialogue among professionals leading to some shared understanding about how to care for patients. Although this institutional dialogue can bring conflict, the moral learning possible within a Catholic hospital faithful to Christ should not be ignored. In this essay I describe the institutional dialogue where this learning takes place as “institutional conscience” and offer it as a convenient way to understand both the rights of Catholic health institutions to practice medicine according to Catholic faith and morals and the duty of those institutions to heal patients using every legitimate means available. Life and Learning XVI 410 U.S. 179 (1973) 1 Among other journals, the National Catholic Bioethics Quarterly frequently 2 publishes articles concerning conscientious objection in health care, now expanded to include a host of issues other than abortion. See for example Richard S. Myers, “On the Need for a Federal Conscience Clause,” NCBQ 1/1 (2001): 2326; Maureen Kramlich, “Coercing Conscience: Mandating Abortion Coverage,” NCBQ 4/1 (2004): 29-40; Nikolas T Nikas, “Law and Public Policy to Protect Health Care Conscience,” NCBQ 4/1 (2004): 41-52. Church Amendment to the Public Health Service Extension Act of 1973, Pub. 3 L. No. 93-95, Tit. IV, § 401 (b), ©), 87 Stat. 95 (codified at 42 U.S.C. § 300a-7) “The Protection of Conscience Project” tracks the issue worldwide at 4 http://www.consciencelaws.org/. The four states offering no conscience protection 414 WHY INSTITUTIONAL CONSCIENCE? The idea of an “institutional conscience” is perhaps most easily seen today as the locus of institutional objection to abortion. The legal culture in the United States has tended to erode this possibility. For example in Doe v. Bolton, the preexisting statute required “that the [abortion] procedure be approved by the hospital staff ethics committee.” The Doe Court found that “the interposition of a hospital committee on abortion...is unduly restrictive of patient’s rights, which are already safeguarded by her personal physician.” By eliminating institutional 1 objection, Doe infringed upon the rights of conscience of every professional acting on behalf of Catholic hospitals. A hospital ethics committee at least provides a forum for professionals to debate and judge what goes on within their own institution. Doe makes this institutional judgment irrelevant for the crucial issue of abortion. The “conscience clauses” enacted by state legislatures and the federal government in response to Doe tried to protect institutions as well as individuals. At the federal level, the Church Amendment prevents 2 public authorities from requiring a health care institution to provide facilities or personnel for sterilizations or abortions. And “The Protection 3 of Conscience Project” website notes that all but four states provide some legal protection for conscientious objection. In their own ways, both the 4