Catholic Nurses and Abortion

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

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.

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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.


Finding Clarke in All Places

When I went to Clarke University to teach nursing I felt I found my soul. I was able to let go and be the person I imagined I was born to be and not the one forged by 20 years of federal rules and regulations. As I taught nursing I learned how to be a better nurse. When I left the spiritual safety of a Catholic university I feared I would regress or in some way have my faith diminished by not being constantly in the presence of those dedicated to freedom, education, charity, and justice. What I didn’t know is that everywhere I go they are present.

Today I went to the Catholic Worker House to help prepare food. It wasn’t the organized preparation we had in St. Louis for the St. Patrick’s meals, but rather the Zen method of taking whatever has been donated and turning it into a tasty and nutritious meal to take downtown to distribute in the park.

One of my tasks was to find the scissors and in the process found Sr. Mary Dennis. She quickly introduced herself and told me she was from Iowa. As soon as I said I had taught at Clarke she beamed and announced she was a Clarke graduate and a Presentation Sister from Dubuque. We talked about our love for the place and what it means to us and promised to talk more over coffee.

I came home to Knoxville, but Clarke and especially the Sisters that helped me with the transition to higher education continue to touch my life and faith. In every city I’ve lived in since I left Clarke I have run into a Clarke graduate and without exception, the one thing they have in common is their love for the place and the life-changing impact.

catholic-worker-logo-1I feel blessed that God sent a Clarkie to Knoxville to live in the Catholic Worker house, care for those that live there, and provide hope to those that are homeless in Knoxville.
Sr. Mary Dennis and the people of the Catholic Worker reminded me that it is my job to carry with me everything I learned from the BVMs. There will always be reminders along the way that we are a community of love and part of sharing that love is recognizing the dignity of every human being. It is the education we have and share with others that helps us develop our gifts and share them. I learned to be free. I will always be free.


When Feminism Meets Southern Lady

It has been a month since I returned home to Tennessee and I quickly remembered what it means to be a Tennessean and why I loved being a Volunteer. People say good morning and actually, mean it. I still remember the psychology professor from New York that told us how it freaked her out when she first came here. In Tennessee, people make eye contact just because it is considered polite to make eye contact when you say hello and to acknowledge even a stranger when you pass them. And, it isn’t uncommon to have a 10-minute conversation in the grocery store with a total stranger. Men still hold the door and will hold it while you climb the steps as if they have all the time in the world. Plumbers, electricians, and all the workers that have been so helpful with the old home I bought quickly treat me with greater caution when I give them the “my daddy taught me…” when it comes to home repairs. The look on their faces say, she may have lost part of the accent, but she didn’t forget how to fix things.

I love being a powerful woman, but I also love wielding the Southern lady.

I learned how much the South has changed. There was a time when a new woman in a university or corporate gym may have been considered a spouse. Yesterday, an older gentleman in the gym assumed I was in a leadership position. I’m sure part of it was the dress I was wearing that clearly gave me away, but still, I remember a time when people would see me in uniform and ask me if I was a stewardess instead of recognizing me as an officer.

I was dressed for success, but a Southern man didn’t assume whose wife I might be and that is progress.

It is nice to see that the Southern ladies have made great progress in the advocacy of women’s rights and equality. After all, a true Southern lady does not stay long in the company of those that cannot respect her. I am grateful to all the female academics, graduate students, and professional women that have worked so hard for equality. I have seen these women every day and they are doing the things that impressed me as a student so many years ago. They take their mission seriously and they take it to the streets. Almost everyone I happen to have met at the university has told me about their work with the homeless, or in an underserved clinic, or with children who were born into poverty, or their mission trips to serve the poor and spread the Word. Yes, it means something to be a Volunteer and that calling to step up lives here.

This leads me to my thought of the day. We can be polite to others and accept the intention of good manners with graciousness. The woman behind the counter that calls me dear is not being disrespectful nor is the plumber that does the same if their intent is to be polite. Communication is not only the words we choose to use, but the tone with which we use them, and the body language when we are talking. Holding a door doesn’t say I am less than a man. In fact, it is meant to show respect even if in doing so it acknowledges a role that is often linked to gender or age.

I’m glad to be home and happy that I am being reminded on a daily basis that there is much to love about the South. It is nice to slow down and remember that I should never be too busy to greet a stranger with kindness and get to know them. I am a feminist, a Christian, and a Southern lady and I love it that in Tennessee I can be all of those things!


Be Aware and Act: I Am Muslim

What does it mean to be compassionate when we see others in distress and know that proposed policies are causing that distress? President Elect Trump’s team has proposed a policy that would be similar to the National Security Entry-Exit Registration System implemented by the Bush administration, which essentially applied to Muslim countries. It was phased out in 2011, but not because it violated civil liberties, but rather because it was redundant. In other words, we already had systems that did essentially the same thing. The ACLU has promised to bring a legal challenge if such a policy is reinstituted, but reality is that controlling entry to and exit from the country is within the authority of the President. A Muslim registry is clearly discriminatory and clearly draws into question how seriously we take freedom of religion, but it probably isn’t unconstitutional.

I’ve seen petitions and much outrage on social media about a Muslim registry. Sign the petition and say you will register as a Muslim if this policy is implemented. The question is what can you do now that is more obvious than signing a petition that no one else sees? I suggest that if you are serious about standing with Muslims that you change your religion on Facebook, Twitter, and anywhere else you have it publically listed to Muslim until the election. My sad speculation is that for many people religion is so much a part of their identity that despite the moral stand they hope they would take they won’t be able to make this little change to show solidarity with Muslims.

My challenge, can we get 1,430,000 people to change their religion on social media accounts to Muslim and leave it that way until the inauguration? 1.43 million is currently Hillary Clinton’s lead in the popular vote. As a Catholic, I confess that it is easy for me to say, but it was hard for me to change my religion online as Muslim. Try it and see if you have the moral fortitude to stand in solidarity with our Muslim brothers and sisters, against discrimination, and for religious freedom.

 

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Faith Meets the 2nd Amendment

“Non-violence is not a garment to be put on and off at will. Its seat is in the heart, and it must be an inseparable part of our being.”  Mahatma Gandhi.

Mask by B. Brecht

Do you hear the screams of the 16,000 murder victims each year?  Do you hear the crying of the 1.8 million assault victims?  Do you see the bloodstain on the carpet when you close your eyes?  Are you still traumatized by the one you lost?  Are you still blaming Cain for the violence or do you have the ability to look inward at your own violence and your own fears and see that violence and fear as part of our culture.

The United States is suffering from a culture of violence.  We blame the victim, but not just the victim of violence.  We blame the poor person for being born into poverty and not pulling himself or herself up by the bootstraps.  We blame the mentally ill who are more often victims of violence than perpetrators of violence.  We blame the rape victim for not being cautious enough or not fighting back hard enough.   We blame the abused spouse for a poor choice or for not seeking a divorce.  It is so much easier to blame than it is to address the issues we have created as a culture.  Our culture of violence did not occur on its own.  It occurred because our hearts changed; and, as our hearts changed we changed laws and policies that allowed the wound of violence to fester and spread.

We have allowed our fear to control us and drive our policy and personal decisions.  Consider some of the recent issues we have faced.  We fear poverty and the mere appearance of poverty.  Consequently, we spend ourselves into debt on an individual and national level.  We purchase bigger homes, cars, and social programs.  We are willing to steal, sell drugs, and swindle others rather than appear to be poor.  We fear other nations and terrorism so we build a more powerful military and enough bombs to annihilate the world’s population.  We build interior security measures that significantly limit our freedoms and make travel unpleasant, even if safer.  We spend enough on defense to eliminate malnutrition.  We fear competition so we cheat on tests, undermine our colleagues, and pass tax codes to lure big business and while they get richer the people get poorer.  We fear the other political party being in power.  Rather than working together for a better society the political parties have become increasingly hostile to compromise and cooperation. We fear pregnancy (both being pregnant and not being able to be pregnant) so we make contraceptives free to delay birth and limit the number of children, promote abortion, use fertility specialist to have children later in life, or use in vitro fertilization when one has no partner at all or can’t conceive otherwise.  We fear death and spend endless amounts of money to delay it and consequently we live well beyond our intended age and grow ever more alarmed at what the end of life is like when it is no longer natural.  We fear people who murder so we murder them with a death penalty.  We fear violence and so we buy weapons of violence and put ourselves at ever-greater risk of dying a violent death.   What we seam to fear are the imperfections of life and suffering.

America Magazine published an article recommending the repeal of the 2nd amendment.  The editors showed courage in writing and publishing the article, but is it wise and is it practical?  When I teach health policy I tell students not to define the solution into the problem and always have clear criteria to evaluate a way forward.   The America Magazine editors define the problem not as violence, but as the inability to enact stricter gun laws.  They admit that this is not the sole solution, but it is the one they address.  To be clear they did not recommend an absolute ban on firearms.  As the editors pointed out, the repeal of the 2nd amendment will not repeal original sin, but it may make a safer world.

Setting clear criteria for evaluation of a policy is critical.  The criteria should be based on legality, political acceptability, respect for human dignity, and the ability to implement the policy.  Any graduate health policy student would tell you that the repeal of the 2nd amendment is not going to happen in the foreseeable future and the attempts to repeal it may derail the legitimate work that needs to be taking place.  As Senator Ted Kennedy learned when he rejected the health care plan President Nixon was willing to support it took 40 more years to negotiate his way back to less.  Let’s not make that mistake with the 2nd amendment.

First, any policy with a reasonable likelihood of success must not violate the constitution, statutory, or common law.  Challenges to the 2nd amendment have lost in the Supreme Court and there is ample case law to support the right to bear arms.  Second, the repeal of the 2nd amendment is not politically feasible at this time.  While the majority of Americans support closing the loopholes on background checks and taking large magazines and assault weapons off the street, they do not support the repeal of the 2nd amendment.  The political will is absent and there is not strong public support for such an action.  Third, would the repeal support human dignity?  That is harder to answer. Doing away with implements of violence clearly promotes human dignity provided they are taken away equally from all and do not leave some powerless.   Finally, is it implementable?  The answer is clearly no.  There are too many people that love their guns.  They clearly love them more than their children, more than their neighbors, and more than peace.  Their fear is so great that they are unwilling to trust that peaceful existence is possible without implements of violence.  Unfortunately, the same acts that the repeal is meant to eliminate are the acts that fuel the fear that will cause people to fight the repeal.  It is highly unlikely that any southern state would vote for the repeal and thus it would not pass.

We do need to explore the policy alternatives and address the culture of violence – the culture of death.  Yet, picking a battle that will only make people more resistant to any effort to make improvements is not necessarily prudent even though it is clearly the most morally responsible action.  If repeal of the 2nd Amendment would end our culture of violence I would support it immediately.

Let’s begin by defining the problem and collecting evidence.  This requires that we come to some consensus on what the problem is and is not.  The laws blocking any collection of data on violence or gun violence must be eliminated.  The people that promote such laws should not fear the truth whatever it turns out to be.

Antonin Scalia, writing following the 2008 Supreme Court Decision striking down the DC gun law said “constitutional rights necessarily takes certain policy choices off the table.”  Therein lies the problem, and to address this problem it is either necessary to address the Constitution, address policy we can change, or address our culture.  Before we change the Constitution I would recommend that we look at the policy and the cultural issues that have resulted in the current culture of violence.  If, after we have researched the actual cause of our cultural shift we find that it is indeed due to guns, then we should explore a change to the Constitution and a revision of the 2nd Amendment.  I highly recommend reading the very thoughtful and well written article in America Magazine located at Repeal the Second Amendment.