Catholic Health Association of the United States
Commentary re: Regulation 45 CFR Part 88 (2008) [Rescinded]
U.S. Department of Health and Human Services
- Note: This commentary refers to a
in December, 2008 by the Bush Administration. It was eviscerated by the
Obama Administration and re-issued in February, 2011. [See
24 September, 2008
Dear Secretary Leavitt:
I am writing on behalf of the Catholic Health Association of the United
States in support of the proposed rule to implement, enforce and promote
awareness of existing federal law protecting the conscience rights of
individual and institutional health care providers.
The Catholic Health Association of the United States (CHA) is the
national leadership organization of the Catholic health ministry,
representing more than 2,000 Catholic health care sponsors, systems,
hospitals, long-term care facilities, and related organizations. CHA
represents the largest not-for-profit provider of health care services in
- 1 in 6 patients in the United States are cared for in a Catholic
hospital each year.
- All 50 states and the District of Columbia are served by Catholic
health care organizations.
- More than 2,000 sponsors, systems, facilities, and related
organizations serve the full continuum of health care.
- Approximately 725,000 individuals are employed in Catholic
The Catholic health ministry in the United States
traces its history to 1727 when French Ursuline sisters arrived in New
Orleans to serve the city's sick and poor and to educate its children.
Almost 80 years later, the same congregation of sisters asked whether they
would be allowed to continue their ministry in service to the community and
fidelity to their faith when Louisiana joined the United States. The answer
came by letter on May 15, 1804 when President Thomas Jefferson reassured
â€¦ that your institution will be permitted to govern itself according to it's
[sic] own voluntary rules, without interference from the civil authority,
whatever diversity of shade may appear in the religious opinions of our
fellow citizens, the charitable objects of your institution cannot be
indifferent to any; and it's [sic] furtherance of the wholesome purposes of
societyâ€¦cannot fail to ensure it the patronage of the government it is
under. be [sic] assured it will meet all the protection which my office can
Today, as in 1804, the Catholic health care ministry works in
"furtherance of the wholesome purposes of society" by serving persons of all
ages, races and religious faiths. Our deeply held religious and moral
convictions are the source of both the work we do and the limits on what we
will do. In recent years, these limits, particularly as they affect health
care, have increasingly become a focus of vigorous public debate. While many
important constitutional, legal and social theories and arguments are
involved, ultimately the central question is whether organizations and
individuals should be required to participate in, pay for, provide coverage
for or refer for services that directly contradict their deeply held
religious or moral beliefs and convictions.
For Catholic health care institutions and professionals, such
requirements would put them in an untenable position. We also believe that,
for society as a whole, such requirements would undermine a long tradition
of pluralism and accommodation, and could result in an overall diminution of
access to health care services. Neither outcome is desirable or necessary.
Our society's commitment to pluralism lies at the heart of our diverse
and vibrant nation. For this pluralism to flourish the health care system
should allow and encourage involvement of the public and private sectors
including voluntary, religious and not-for-profit organizations, and it
should respect the religious and ethical values of patients and health care
providers alike. Catholics and other with deep respect for the sanctity of
life must not be forced to perform procedures - such as the taking of the
life of the unborn - that are contrary to their deeply held moral beliefs
and principles. The Catholic health care ministry remains committed to
serving the health needs of all, and to achieving genuine health care reform
in a context that respects the contributions and rights of conscience of
religiously affiliated health care providers.
For this reason, CHA has long supported and worked for the enactment of
conscience clause protections such as the Church Amendments, provisions in
the Public Health Service Act, and the Weldon Amendment. We view these
existing legal protections as essential for the continuation of both our own
ministry and our nation's commitment to freedom of religion and of
conscience. Recent events, however, demonstrate a lack of awareness of and
respect for these protections.
Over the past few years, we have seen a variety of efforts to force
Catholic and other health care providers to perform or refer for abortions
and sterilizations, including national advocacy campaigns targeting Catholic
hospitals; efforts by state governments to undermine the conscience rights
of health care providers; and the American College of Obstetricians and
Gynecologists proposing to redefine the standards for ethical practice to
force doctors to provide or refer for abortions or sterilizations. In light
of these attacks on the health care providers' conscience rights, your
department's regulatory proposal to implement existing federal conscience
law is welcome.
We suggest that the regulation be clarified in two areas, to strengthen
it and ensure effective compliance and enforcement. The regulation should
clarify that federal conscience protections extend to those who understand
abortion to include the destruction of an embryo prior to implantation. In
addition, the regulation as currently drafted is difficult to follow with
respect to which requirements and certifications apply to, and are
appropriate for, which individuals, institutions and governmental entities.
CHA's mission and ministry are grounded in the values that drive each of
our organizations. Our ethical standards in health care flow from the
Catholic Church's teachings about the dignity of the human person and the
sanctity of human life from conception to natural death. These values form
for the basis for our steadfast commitment to the compelling moral
implications of our heath care ministry, from insisting on the right of all
to accessible, affordable health care, to caring for persons at the end of
life, to defending and preserving the conscience rights of health care
providers, including but not limited to Catholic facilities and individuals.
Once again, thank you for promulgating regulations to ensure the
continued enforcement and viability of federal conscience protections.
Sr. Carol Keehan, DC
President and CEO