I returned from New Mexico where I visited San Felipe de Nero Church and bought a new Rosary. Not because I needed another Rosary, but because it is as beautiful and I find the faith. I was reminded that I never finished this post probably because I’m conflicted about the issue of abortion in some circumstances, but not the least bit conflicted about the religious freedom of nurses to decline to participate in abortion when they have a reexpressed objection.

Protecting Statutory Conscience Rights in Health Care issued by the Department of Health and Human Services (HHS) in April 2019 broadens the ability of HHS to enforce existing laws preventing discrimination based on conscience and essentially reinstated the 2008 rule with enhanced enforcement and clear definitions. The most significant change beyond enforcement is the definition of “assist in the performance” which is now “to participate in any program or activity with an articulable connection to a procedure, health service, health program, or research activity, so long as the individual involved is a part of the workforce of a Department‐funded entity.” It does not override existing law including EMTALA.

As part of the background for instituting the rule, HHS cited the cases of nurses who exercised their conscience rights and suffered discrimination as a result.

In 2010, Nassau University Medical Center disciplined eight nurses when they raised objections to assisting in the performance of abortions.26 Nurses in Illinois and New York filed lawsuits against private hospitals alleging they had been coerced to participate in abortions. Mendoza v. Martell, No. 2016‐6‐160 (Ill. 17th Jud. Cir. June 8, 2016); Cenzon‐DeCarlo v. Mount Sinai Hosp., 626 F.3d 695 (2d Cir. 2010). A nurse‐midwife in Florida alleged she had been denied the ability to apply for a position at a federally qualified health center due to her objections to prescribing hormonal contraceptives. Hellwege v. Tampa Family Health Ctrs., 103 F. Supp. 3d 1303 (M.D. Fla. 2015). Twelve nurses in New Jersey sued a public hospital over a policy allegedly requiring them to assist in abortions and for disciplining one nurse who raised a conscientious objection to the same. Complaint, Danquah v. University of Medicine and Dentistry of New Jersey, No. 2:11‐cv‐6377 (D.N.J. Oct. 31, 2011).

Rosary from San Felipe de Nero Church

One can easily argue that the rule goes too far and favors the provider over the patient and that it makes it difficult for people in rural areas or areas where the only access to care is through a faith-based hospital or clinic. However, it does not prevent any facility from providing reasonable accommodations to the healthcare worker in such cases. In other words, as an administrator, if I know that a nurse objects to participating in abortion I can reassign that nurse to other responsibilities to prevent the nurse from having to violate conscience. That is not to say that the nurse could be reassigned to non-nursing duties, but other nursing duties.

What does it mean to be a Catholic nurse?

Long before I understood and deeply pondered Catholicism I knew I wanted to be a registered nurse. The decision to become a family nurse practitioner came much later, but the reasons are similar. Nurses provide for the holistic health care needs of others. The care provided ranges from education, to preventive services, to highly technical care. It can and does frequently include care for the needs of family members, addressing social concerns, and spiritual care. As a nurse, it is a privilege to walk with people as they journey through life.  However, there are times that their journey may take them down a path where I chose not to follow. As a provider, I have always ensured I understand my responsibilities so that any conflicts would be clear upfront. I’ve intentionally avoided jobs that would put me in regular conflict with my beliefs.

When I entered nursing there was no social contract that said I must give up my immortal soul to be a nurse. If you ask me to participate in abortion you are asking me to commit a mortal sin, risk excommunication, and take a life. I passionately disagree with the belief that “If you don’t want to provide abortions, don’t go into healthcare.” It is as if there is one truth and those of some faith traditions don’t know it. Of course, that lack tolerance goes both ways as anyone that has ever interacted with the “Right to Life” movement knows. Of equal importance is the fact that the vast majority of health care has absolutely nothing to do with abortions so why would one believe that a refusal to participate in abortion should be an exclusion criterion?

“Those that proclaim themselves to be the sole measure of realities and of truth cannot live peacefully in society with their fellow men and cooperate with them.”

—Compendium of the Social Doctrine of the Church

The Pew Research Center has a great deal of research on where major religious groups stand on abortion.  However, official teaching does not mean that members believe that abortion should be illegal or even that religious people don’t have abortions at the same rate as the general population. One of the beauties of the United States is that we can freely practice our religion and for the most part firmly believe we should not force that religion on others. Thus, I can be Catholic and believe that while you should not have an abortion in most cases that you currently have the Constitutional right to make that choice.

I will not block your way or give you false information if you seek an abortion. In fact, I will do my best to give you all the relevant information. That is where I part ways with the new regulation. I do believe we have a responsibility to refer a person to another provider that shares their beliefs if that is what they desire. I also believe that I must always be honest with the patient. If as a provider I am unwilling to instruct a patient on abortion I should be upfront that my beliefs prevent me from doing so. The regulation does require facilities to post or give notice about what they will not do based on religion but does not require a referral to someone that will provide the requested information or care. While it appears clear that notice must be given to the patient about the limitations of services I worry about the willingness of this administration to enforce that section.

What would it mean to have no Catholics in healthcare?

Approximately 21 percent of the population of the United States of America is Catholic. Therefore, it would be reasonable to assume that 21 percent of all nurses in the USA are also Catholic. There are 660 Catholic hospitals and 1644 Catholic continuing care facilities in the USA alone. There are approximately 750,000 employees caring for almost 5 million admissions including 1 million on Medicaid each year. That equates to 1 in every 7 patients being treated in Catholic facilities.

If one excluded all Catholics that followed the teaching of the Church from practicing it would devastate our healthcare system. We would lose about 15% or our hospitals many of which serve already underserved areas. We would also lose about 20% of our nurses and physicians which means many would go without care.

A rational solution not based on hate of those who choose life.

As nurses, we have the ability to see the world in a way few can. We have walked with those that are rich and poor, from many cultural backgrounds, many countries, and just as many perspectives. We have seen people experience great pain and great joy.  We have cared for the victim of violence and the person that committed violence. And, we have always tried our best to provide compassionate care.

I believe that Catholicism made me a better human being just as Soto Zen practice does. In stating our beliefs, we may find common ground that brings us together to find solutions that don’t criminalize acts of fear and desperation or ignore the needs of women whose beliefs do not equate abortion to wrongdoing.

Here is what I believe:

• Women are fully human – not less than men or human embryos or human fetuses.
• A human embryo has all the genetic material of a human being but is not sentient from the time of conception.
• The human embryo/fetus is drawing its life from the mother.
• Self-determination should be a right for all sentient beings – rights come with responsibilities to make moral decisions.
• Pregnancy is a choice in most circumstances – rape, incest, and the life of a mother are special circumstances that force choices between the good of the human embryo and the human fetus and the good of the mother.
• Contraception meant to prevent implantation is not equivalent to abortion – it does violate the teaching of the Church, but can result in a reduction of abortions.
• Poverty, abuse, lack of childcare, fewer education options for women with children, fewer job opportunities and discrimination against women with children, and inadequate support for those that are pregnant impact a woman’s decision to have an abortion.
• Abortion is a moral and healthcare decision – women are endowed with consciences and can make moral decisions.
• Pregnancy is stigmatizing – society values fertility, but not always the pregnant woman especially if she is unwed or poor.
• The objective act of abortion being immoral does not equate to the person carrying out the act as either good or evil.

The compassionate solution cannot be to build a wall between women and legal and safe abortion and expect it will end abortion. We should begin with compassion and start by passing laws and making policy changes that will encourage giving birth and value pregnancy.

• Paid maternal leave for six months
• Affordable childcare based on income
• Educational support for pregnant teens and new moms
• Adequate nutritional assistance for all women of childbearing age
• Free adoption
• Women’s health care in all communities that is free to all women of childbearing age
• Corporations that don’t disadvantage women with children

Nurses must practice in a manner that gives great consideration of the patient’s needs. This requires carefully working with an employer in advance to ensure one’s views don’t unreasonably compromise access for a patient.  Nursing is a big profession with many options so it is important to consider options.

• If a portion of a job violates one’s conscience think carefully about the extent to which one’s views impact the care of the patient.
• Make any conscience objections known in advance and in writing.
• If one’s views would prevent providing life-saving care then it is inappropriate to take the job.
• Always show respect for the patient which can be done without violating one’s own conscience.

Like no other, the nurse has a direct and continuous relationship with patients, takes care of them every day, listens to their needs and comes into contact with their very body, that he tends to. –Pope Francis

Let us as nurses show the same compassion to and respect for each other.

Catechism of the Catholic Church on Abortion

Abortion

2270 Human life must be respected and protected absolutely from the moment of conception. From the first moment of his existence, a human being must be recognized as having the rights of a person – among which is the inviolable right of every innocent being to life.⁷²

Before I formed you in the womb I knew you, and before you were born I consecrated you.⁷³

My frame was not hidden from you, when I was being made in secret, intricately wrought in the depths of the earth.⁷⁴

2271 Since the first century the Church has affirmed the moral evil of every procured abortion. This teaching has not changed and remains unchangeable. Direct abortion, that is to say, abortion willed either as an end or a means, is gravely contrary to the moral law:

You shall not kill the embryo by abortion and shall not cause the newborn to perish.⁷⁵

God, the Lord of life, has entrusted to men the noble mission of safeguarding life, and men must carry it out in a manner worthy of themselves. Life must be protected with the utmost care from the moment of conception: abortion and infanticide are abominable crimes.⁷⁶

2272 Formal cooperation in an abortion constitutes a grave offense. The Church attaches the canonical penalty of excommunication to this crime against human life. “A person who procures a completed abortion incurs excommunication latae sententiae,”⁷⁷” by the very commission of the offense,”⁷⁸ and subject to the conditions provided by Canon Law.⁷⁹ The Church does not thereby intend to restrict the scope of mercy. Rather, she makes clear the gravity of the crime committed, the irreparable harm done to the innocent who is put to death, as well as to the parents and the whole of society.

2273 The inalienable right to life of every innocent human individual is a constitutive element of a civil society and its legislation:

“The inalienable rights of the person must be recognized and respected by civil society and the political authority. These human rights depend neither on single individuals nor on parents; nor do they represent a concession made by society and the state; they belong to human nature and are inherent in the person by virtue of the creative act from which the person took his origin. Among such fundamental rights one should mention in this regard every human being’s right to life and physical integrity from the moment of conception until death.”⁸⁰

“The moment a positive law deprives a category of human beings of the protection which civil legislation ought to accord them, the state is denying the equality of all before the law. When the state does not place its power at the service of the rights of each citizen, and in particular of the more vulnerable, the very foundations of a state based on law are undermined. . . . As a consequence of the respect and protection which must be ensured for the unborn child from the moment of conception, the law must provide appropriate penal sanctions for every deliberate violation of the child’s rights.”⁸¹

2274 Since it must be treated from conception as a person, the embryo must be defended in its integrity, cared for, and healed, as far as possible, like any other human being.

Prenatal diagnosis is morally licit, “if it respects the life and integrity of the embryo and the human fetus and is directed toward its safeguarding or healing as an individual. . . . It is gravely opposed to the moral law when this is done with the thought of possibly inducing an abortion, depending upon the results: a diagnosis must not be the equivalent of a death sentence.”⁸²

2275 “One must hold as licit procedures carried out on the human embryo which respect the life and integrity of the embryo and do not involve disproportionate risks for it, but are directed toward its healing the improvement of its condition of health, or its individual survival.”⁸³

“It is immoral to produce human embryos intended for exploitation as disposable biological material.”⁸⁴

“Certain attempts to influence chromosomic or genetic inheritance are not therapeutic but are aimed at producing human beings selected according to sex or other predetermined qualities. Such manipulations are contrary to the personal dignity of the human being and his integrity and identity”⁸⁵ which are unique and unrepeatable.