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Catholic Church, politics

Paternalism and the “Contraception Mandate”

One response to my previous post – in which I critiqued the widespread Catholic outrage over HHS’ so-called “contraception mandate” – deserves its own follow-up, because it gets to the heart of a lot of objections raised in the Catholic world about health insurance coverage of reproductive services in general, and specifically about this latest HHS mandate.

This self-identified Democratic-leaning independent reader’s critique was, put simply, that even if they don’t object to women having access to contraception, people (such as [a small percentage of] Catholics) who object to contraception should not be forced to pay for other people’s use of it.

That this is also how the U.S. bishops are looking at the issue is shown in their response to the Obama administration’s recently proffered compromise (in which employees could receive free contraception directly from the insurer, paid for by the insurance company rather than by the Catholic hospital, university, or charity):

In the case where the employee and insurer agree to add the objectionable coverage [read: contraception coverage], that coverage is still provided as a part of the objecting employer’s plan, financed in the same way as the rest of the coverage offered by the objecting employer. This, too, raises serious moral concerns.

In other words, the bishops, like my reader, object to paying for something they find morally offensive.

On the surface, of course, this is a very compelling argument. None of us likes for our money to fund morally objectionable practices. It’s the whole principle behind Fair Trade and socially conscious investing. I don’t want my money to fund the exploitation of farmers and their families because I find that morally evil and degrading to human dignity; similarly, objectors to the HHS mandate argue, why should they be forced to pay for other people’s contraception if they think it is a moral evil that degrades human sexuality?

Now, of course, the question of who is really doing the paying when it comes to private insurance plans (like these Catholic institutions would have) is a separate one entirely – but suppose that for the sake of argument, we grant that just by paying my bill at a Catholic hospital or university I am thereby paying for the health insurance coverage of employees. Thus, my hands are dirtied if that insurance coverage includes contraception – and likewise, if the administrators of said institution are required to offer such health insurance, they are being forced to implicate themselves in moral evil.

Here’s the problem with this argument. If an employee goes out and buys contraception with her salary because it’s not included in her health insurance coverage, aren’t my hands as a customer of that Catholic institution – or the “objecting employer’s” hands who paid the salary – just as dirtied, since her salary comes from this Catholic institution just like her health insurance does? Aren’t we – by this logic – therefore subsidizing her violation of Catholic teaching, simply by virtue of paying her a salary?

The point is, when it comes to paying for something one morally objects to, there is no meaningful difference between paying employees salaries (which they may as freely spend on birth control or donations to Planned Parenthood as on rosaries and prayer books) and providing health insurance coverage that simply subsidizes reproductive services. The money still comes from the same place, and it’s not like employees of Catholic institutions have any illusions about what the official Catholic position on birth control is, so it’s unlikely they’d take this mandated health insurance coverage as tacit approval by the institutional Church.

In other words, unless Catholic employers are willing to declare that they will not hire or pay employees who do not follow every particular of official Catholic teaching, they are just as much funding immorality (as they see it) whenever employees choose to purchase contraception (or anything else the employer morally objects to) as they would be by simply offering health insurance that covers contraception.

In short, what’s at issue in this debate over the “contraception mandate” is not religious liberty; rather, the issue is to what extent employers can and should control how employees choose to use their resources. This outrage about being forced to pay for other people’s abortions or contraception is really based in an anxiety over the personal agency of individuals employed in Catholic institutions – that if contraception is included in their insurance, they will of course choose to use it, and thus they must be protected from making that choice. Such an anxiety is fundamentally based on a patronizing and paternalistic view of employees and, ultimately, women, who cannot be trusted to make conscientious decisions on their own.

Now that’s something worthy of outrage.

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12 thoughts on “Paternalism and the “Contraception Mandate”

  1. I am befuddled by this issue of providing contraceptive coverage as the Church being forced to promote bad (evil) choices…as Catholics being forced to promote what is anathema to Catholics.

    Our Creator puts us in a world where we are daily presented with choices between right action and the opposite.

    God does not keep poor (or forbidden) options hidden from us. He does not keep other women from my path when I marry. He does not eliminate the open shelves of a grocery store from my path to avoid the possibility that I might steal from its shelves. Guns exist in spite of the poor choices that might result from their ownership or use.

    At every point God says, I have faith in you to choose rightly.

    Is He promoting or condoning my poor choices by allowing them to be available to me generally in the world? To allow a choice is not to condone it. It only acknowledges what is already present in the world. The call to right action is my own. Paradoxically, it may even be argued that removing choice pushes one toward the opposite of the preferred option.

    If God does not prevent the occasion for poor choices why does the Church think it can do better?

    The mandating of personal morality is a tricky business that always seems to involve someone who knows better than someone else. In this case it is the bishops who know better than the huge majority of the Catholic laity that ignores the Church’s teaching on birth control. From a practical standpoint this seems like a non issue…even for the bishops.

    I am forced to conclude the only reason the bishops are agitating over this issue is to make a point about the degree of freedom they feel the Church is due. The issue itself does not merit pressing the point to the limit in the same way abortion might.

    Posted by Mike Fazzini | February 13, 2012, 9:52 pm
  2. The “paternalism” card? Oh, brother.

    First, the Catholic Church and her entities are not responsible for what employees do with their salary. The employees can spend it on drugs and porn, and the Church is not culpable in the least. But, if the Church directly buys the drugs and porn for the employee, even if they are supplied by a middle man whom the Church pays to supply them, then yes, the Catholic entities who do so are culpable.

    Perhaps Catholic moral theology is of no interest to you (or you disrespect those who are faithful Catholics), but I’m going to lay it out anyway. From the Catechism of the Catholic Church:

    (1868) Sin is a personal act. Moreover, we have a responsibility for the sins committed by others when we cooperate in them:

    - by participating directly and voluntarily in them;

    - by ordering, advising, praising, or approving them;

    - by not disclosing or not hindering them when we have an obligation to do so;

    - by protecting evil-doers.

    You see, it doesn’t matter if you agree with Church teaching, or think it’s a big joke, or think it’s based on paternalism or even voodoo. It only matters that the Catholic Church teaches that it is a sin to buy/supply/provide/facilitate contraceptives to others, even buy paying a middle man. (If I pay a hit man to kill my husband, I am still culpable for the sin, even though I didn’t kill him directly.)

    Again, it doesn’t matter if you agree or think we are fools. The Constitution says that I am free to exercise my faith. And if the government can mandate that I sin, then I am not free to exercise my faith. No one has the right to tell me that I *must* sin, or else be fined or jailed. Especially not the federal government, which has been prohibited from interfering with my free exercise of religion.

    Come on over to my blog. You will learn a lot more about the Catholic Faith, and we have some very lively debates. You’ll be challenged in your thinking, but you seem intelligent, and I am sure you are up for it.

    Take care!

    Posted by Leila | February 14, 2012, 2:02 am
    • Leila,

      Opponents of the mandate – like you – like to frame this issue as employers being forced to buy contraceptives and thereby violating their own consciences, religious liberty, etc. This misses the point. The employee has to choose to use birth control, just as if she buys it with her salary. The employer is not pre-emptively buying it for the employee. The employer is simply providing a resource – health insurance – and the employee is choosing how to use it, just like she may choose how to use the resource of her salary. Treating employees as adults means allowing them to use their resources as they choose, within the bounds of the law.

      In other words, the employer is no more culpable for how the employee uses the resource of her health insurance than for how she uses the resource of her salary. Theoretically, no employees may choose to use contraception, despite it being included in their insurance coverage. And of course, as many have pointed out elsewhere, contraception is prescribed for many other reasons apart from family planning. Catholic employers can fulfill the mandate of the CCC you cited, Leila, by doing their best to persuade their employees that the Church’s prohibition on birth control is right and just; after all, as you pointed out, “sin is a personal act” – after they’ve done their best to explain the Church’s teaching, the moral decision is ultimately up to the employee.

      It is that moral decision-making that opponents of the mandate want to take away in the name of “religious liberty.” That is why I have called their and your opposition fundamentally paternalistic, because it treats employees as children incapable of making moral decisions for themselves.

      Posted by Kari J. Tremeryn | February 15, 2012, 6:02 pm
      • Kari, what do you think of this: I give my friend $500 for an abortion, but she decides not to go through with it. Have I sinned?

        I am not sure why you think the Church is so paternalistic (I think you should actually say maternalistic, since the Church is traditionally referred to as “she”). Do you think she does not know that many of her employees use contraception? That it is easily available to them? She is not naive. Nevertheless, it violates her conscience and causes her to sin to subsidize her employee’s sexual sin. The government has no right to do so. I won’t presume to know your personal views on contraception, but perhaps to see this more clearly, you should run through the scenario with another action, one that is easily understood as sinful (as Leila mentioned, perhaps hiring a hit man).

        Posted by Meg | February 15, 2012, 7:26 pm
        • Meg,

          Please respond to my actual point about the distinction between salary and insurance.

          Also, hiring a hit man is illegal; contraception is legal. Thus your alternative scenario is irrelevant here.

          Posted by Kari J. Tremeryn | February 15, 2012, 9:16 pm
          • Kari,

            With insurance, an employer is directly funding certain goods and services to be offered to an employee. A wage is a monetary compensation for services rendered; use of wages is to the discretion of the employee. The end might be the same (employee obtains and uses contraception), but that doesn’t mean there is no meaningful distinction when it comes to moral culpability. Indeed there is.

            I suggested you use an alternative scenario to help you determine moral culpability (so for this end, legality is actually what is irrelevant). I’m sure we both would agree that hiring a hit man to murder someone is immoral. So what if someone else foots the bill for your hit man, and then you go on to arrange the kill. Is the “someone else” who directly funded the hit man morally culpable?

            To your point addressed to Leila, regarding the employee having to choose to take advantage of the contraceptive coverage: morally, for the employer, it doesn’t matter whether or not she chooses it. If I pay for a friend’s abortion, even though she ends up not going through with it, have I or have I not sinned in my direct monetary funding and cooperation for something evil?

            I remember you from college, and I hope you’re well. It seems, though, that you feel victimized or condescended to, perhaps specifically as a woman, by the Church in some way. Is that so?

            Posted by Meg | February 15, 2012, 11:52 pm
  3. In response to Leila’s comment above.

    I appreciate your comments above, they give me pause but please consider this.

    If I am a US citizen and I am opposed to the Afgan war I am still required to pay my taxes in order to support the government that is fighting that war. Whether I am a Quaker and by definition and as part of my religious belief I find war reprehensible and evil, I do not get a tax break.

    Even if, as a Quaker, I can claim conscientious objector status and not be made to fight in that war I still am compelled to pay my taxes. I am not allowed to pro rate my taxes to exclude that portion of my debt that goes to pay for the war. I must pay all that I owe.

    The contraceptive coverage issue it not unlike the issue above. It is an issue that rallies Catholics to claim the status of persecuted when the facts do not support this. Catholics are free to gather and worship. They are free to claim tax exemptions for their religious, educational and medical institutions. They are free to represent their faith on the airwaves and in the print media. Catholics enjoy the freedom to be represented openly in every area of private and public life in the US including running for the highest office in the land. Is this common in countries where the faith is under attack?

    Being asked to participate in the commons in the way that every other citizen group does is not the same as being persecuted or targeted. If you think it is then I invite you to step back for some perspective.

    In America there are over 2,000 denominational religious groups. Can each of these groups be honored in every particular of what it means to be a whatever? If your faith cannot be accommodated in every particular of what it means to be a Catholic it is because as Americans we are called to share.

    We are asked to share those things we have in common; roads, schools, hospitals, government buildings, airports, and the like. To behave in a way that promotes what has been legislated to be the common good.

    Being asked to offer contraceptive insurance coverage to hospital employees is being asked to participate in the commons in the way every other group is participating.

    While both war and contraceptive coverage may be in opposition to one’s religious beliefs, unless I am mistaken, and I will freely admit I could be on this point, they have been legislated to be a contribution to the common good.

    As I see it, and in fact I do hesitate to speak for anyone, especially the President, the key point the President is making is that no one is exempt from participating in the commons in the way that every other group has been asked to do. It is not a personal attack on Catholicism yet the rhetoric in return has been very sharp and in many ways disrespectful.

    Catholic institutions are not being singled out as the only ones asked to provide contraceptive coverage. They are being asked to do their fair share in an unfair world.

    Posted by Mike Fazzini | February 14, 2012, 5:40 pm
  4. I’m sure Leila could reply for herself, though she seems to be quite busy over at her own blog. I’ll give you my thoughts, Mike.

    I do think you make an interesting point, and I wonder if there may be some cases where there can be legitimate moral reason to withhold some tax dollars in civil disobedience to things that the government does that go against our beliefs. I don’t really want to delve into it, because I’m honestly not sure, and for this discussion, it’s irrelevant because there is a significant difference between your tax scenario and the HHS mandate.

    I came upon this quote that someone put over at http://littlecatholicbubble.blogspot.com/ that explains it better than I could:

    From http://www.bookwormroom.com/2012/01/30/obamacare-the-catholic-church-and-mandatory-abortion-payments/:

    I assume that those who are celebrating this mandate will contend that, throughout the Bush years, they were forced to see their tax dollars go to fund a war they did not support, one that saw thousands of people die. Likewise, those who oppose the death penalty must nevertheless pay taxes that fund the judicial and prison system. That argument is a red herring. The Constitution explicitly authorizes both war and capital punishment, which are legitimate government powers. Those who don’t like that reality are welcome to try a Constitutional amendment to wipe out the government’s war powers and do away with capital punishment. I don’t see that happening anytime soon.

    There is nothing in the Constitution, however, that authorizes the Federal government (and, by extension through the 14th Amendment, any state government) to mandate that a religious institution be complicit in an act it believes constitutes murder. More to the point, the Constitutional grant of religious freedom, by which the government agrees to stay out of managing a religious institutions affairs, either practical or doctrinal, should prohibit such conduct entirely. This is one more example, as if we needed it, of the Obama administration’s fundamental lawlessness.

    That came from the blog of a Jewish lawyer; as such he likely doesn’t even agree with the Church’s stance on contraception, but it doesn’t really matter since this is truly a matter of religious liberty. In fact, there are groups of all different faiths coming out of the woodwork that oppose this mandate. Seeing as how the Catholic Church stands alone in her opposition to contraception, we can assume that those other organizations and faiths recognize that birth control really isn’t what this is about. In fact, it’s interesting to me that the only people I have really come across that support this are either entirely secular or Catholics who do not adhere to the Church’s infallible teaching in this matter.

    And never mind the idea that contraception is something that works towards the “common good.” That is highly debatable. Even categorizing contraception as “health care” let alone “preventative” is another stretch. But that is all tangential; this is a defense of religious liberty.

    Posted by Meg | February 15, 2012, 5:10 pm
  5. Meg,

    Thanks for your reply. I remember your name from college, too. This is not in fact a personal issue for me, however, although the Catholic Church does indeed have a demonstrably murky history with regard to women. (I think few female FUS theology majors realize that women were not even allowed to study Catholic theology until the second half of the 20th century, for example.)

    The reason I say that your hit man example is irrelevant is that this is a policy discussion, not a moral discussion. That means it deals with existing law. Of course we all want policies to reflect moral values, but the path to that is by changing laws – not by blocking policies that take into account already existing laws.

    Here’s a hypothetical situation that is more relevant to the case at hand. Suppose I am a Catholic working for a Christian Scientist. The Church of Christ, Science, opposes vaccination. Say that, to avoid a nationwide H1N1 pandemic, the U.S. government required that employer-provided health insurance must cover flu shots. This would encourage people to get vaccinated, but no one would be required to be vaccinated. Vaccination, like contraception, is legal, but employers would naturally not be asked to provide the flu shots themselves; they would simply be required to provide insurance coverage should employees choose to take advantage of it. Christian Science employees would probably not choose to use that coverage, but other employees probably would. Should my Christian Science employer be permitted, on religious grounds, to refuse to provide such coverage, thereby making it more difficult for my family to receive vaccinations? Is the government, by trying to prevent a flu pandemic that would affect citizens of all faiths, violating the religious liberty of employers who consider vaccination a sin?

    The only difference between this vaccination example and the current situation, from the standpoint of crafting national policy that takes into account citizens of all different faiths, is that those opposing the HHS mandate are louder and better funded than the Christian Scientists who oppose vaccination.

    It’s fine to oppose vaccination, or contraception, but unless these things are made illegal, national policies must be crafted with both current law and accepted medical views in mind – namely, that contraception and vaccinations are legal and have medical value. Those who disagree with such views and want to stop the use of contraception and vaccinations should by all means try to change the accepted medical view and/or the laws. However, they should not be given religious exemptions from national policies that are in accord with both current law and medicine.

    Posted by Kari J. Tremeryn | February 16, 2012, 2:58 pm
    • Kari,

      No, Christian Scientists should not have to pay for vaccinations if they deem them immoral. Vaccinations are nevertheless available to their employees and they can purchase them with their own money. If it is such a hindrance for said employees, they are free to find work somewhere else or perhaps purchase their own insurance rider that covers it.

      But you are changing your argument. The reason why, for the sake of analogy, legality doesn’t matter is because your previous argument posited that there was no difference between insurance and salary (hence you wrote in response to Leila: “the employer is no more culpable for how the employee uses the resource of her health insurance than for how she uses the resource of her salary”) You spoke of culpability, which is why using a hit man scenario might clarify the responsibility of the employer when they are footing the bill for something.

      In our real life controversy, what matters is whose money is paying for the contraception: with insurance, it’s the employer’s, with salary, it’s the employees. That is the meaningful distinction. What is happening here, whether you agree or not, is that employers are being forced to directly fund contraceptives for the employee. Regarding the employer’s moral culpability, it doesn’t matter whether or not the employee decides to use the contraceptive coverage. Hence my question: If I give my friend $500 for an abortion, and she decides not to go through with it, have I sinned? Twice I have asked and you still haven’t answered, so I’ll tell you the answer: Yes, in virtue of funding an abortion, I have sinned. So it is with the Church: in virtue of funding contraception, she has sinned.

      It is outside the bounds of the government to mandate that a person or entity violate their beliefs by purchasing a particular product. Essentially, the government is mandating that we sin. It truly is a religious liberty argument. I hope you begin to see that because it’s very serious when our liberty is threatened. Take heed that (last I heard) all but 5 bishops issued statements agains this mandate, as well as many lay Catholic leaders in this nation, including several who publicly endorsed Obama in 2008.

      Your brother is Pole, right? He and I did prison ministry together, but I’m not sure if I’m remembering correctly if you two were siblings… Well, thanks for the dialogue. Blessings!

      Posted by Meg | February 16, 2012, 4:18 pm
      • Meg,

        Yes, Poul is my brother. That explains why I remember your name.

        I do appreciate the consistency of your view. I hope that you will never have to choose between feeding your family and vaccinating them against serious illness. I also hope that you never lose an ovary like a Georgetown student described in a January 30 NY Times article that I read earlier today. She had polycystic ovary syndrome, for which she was prescribed birth control by her doctor. Georgetown denied her coverage for the treatment in the name of Catholic teaching against contraception. Because she couldn’t afford the prescription otherwise, she developed a cyst and lost her ovary. This is a prime example of the real life cost of this debate. (http://www.nytimes.com/2012/01/30/health/policy/law-fuels-contraception-controversy-on-catholic-campuses.html?pagewanted=2&_r=2&ref=todayspaper)

        Posted by Kari J. Tremeryn | February 16, 2012, 9:01 pm
        • Kari, It is unfortunate that the woman lost her ovary, but our religious and moral convictions are of the utmost importance. Given my personal experiences, what I find tragic in that situation is that her doctor believed birth control was actually a way to treat her PCOS. As a woman who has 6 years of infertility behind me, I can assure you that birth control is seen as a “fix” for many gynecological problems and thus overprescribed. I myself was instructed to take birth control for the treatment of recurring ovarian cysts, but refused because it only serves to mask problems and not as authentic treatment of the underlying problem.

          My maiden name is Stephens, so that might help place me. :)

          Posted by Meg | February 16, 2012, 10:26 pm

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