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Morning. My name is Sarah Manning and I am speaking as a member of this
church and a Unitarian Universalist. I believe that today we need to
consider whether trends in our American society are in accordance with
our UU principles and, if they are not, we must figure out what to do
about them. Thus the title of this sermon: In Good Conscience. (Isn’t
that a good title for a sermon? I lifted it from the title of the
document I’m going to discuss this morning!)
The debate over health care reform is on the wrong track because it
focuses only on the way we fund health care. But health care should be
considered as fundamental a right as is our right to freedom of
religion. Until we address the right to health care we will be stuck
with band aid and partisan fixes to our current system. Our system is an
amalgam of private-for-profit providers, private-non-profit or religious
providers, and paid for by the US tax payer providers. Three different
sets of providers with different purposes and goals. Our system lacks a
cohesive overview, it lacks a set of ethics by which standards may be
set, by which goals may be determined, by which progress may be
measured.
I’m going to argue that we UUs, along with members of other liberal
religions, offer our ethics as the basis for providing health care in
this country. The Catholic Church has offered health care based on
religious teachings for hundreds of years. And the religious right has
done a superb job of instilling their principles into medical policies
of US regulatory agencies and of influencing the public conversation
about how health care is to be delivered. It is time for us to offer a
better set of assumptions to base public policy on. Make no mistake: I
do believe that our ethics are more compassionate and useful in this
world than either the Catholic faith’s, the Religious Right’s, or the
market economy based upon capitalism. Why? Because we of liberal
religion respect differences. We assume that this world is filled with
peoples of different cultures, backgrounds, faiths, worldviews, sexual
orientation, economic opportunities, access to education, and needs. We
also look to affirm and promote Justice, Equity and Compassion in Human
Relations. That is the 2nd of our 7 principles. I could re-state it as
Justice, Equity and Compassion in Health Care.
The genesis of this sermon is a document entitled In Good Conscience:
Guidelines for the Ethical Provision of Health Care in a Pluralistic
Society which is published by the Religious Coalition for Reproductive
Choice (RCRC.) Many people are not familiar with RCRC so I’d like to
tell you a bit about them. The Religious Coalition for Reproductive
Choice started out in 1973 as a group of clergy representing many faiths
who offered full option counseling to women and men facing a crisis
pregnancy. Even today, anyone can call a local hot line and ask to speak
with a rabbi, or an Episcopal, Presbyterian, UU, or United Methodist
minister and discuss all available options from the perspective of their
own faith. Clergy are also available who can counsel from Buddhist,
Hindu and Muslim perspectives as well. The Religious Coalition for
Reproductive Choice is a national organization with state chapters and
works to provide “public policies that ensure the medical, economic, and
educational resources necessary for healthy families and communities
that are equipped to nurture children in peace and love” focusing
specially on low-income and minority families. RCRC has been paying
close attention to the policies of the Bush administrations and the
activities of the Religious Right, and has also published a report
entitled, “The Medical Right: Remaking Medicine in Their Image.” The
UUA, the UU Women’s Federation, and Young Religious UUs are member
organizations of this coalition.
The trends that RCRC has been monitoring are scary and speak to the
underlying purposes of those who provide health care. Medical providers
in growing numbers are basing the care they give upon their own
perspectives, in particular their own religious perspectives. As you
might expect in a political climate where the religious right has become
adept in voicing their agenda, this trend is clearest in reproductive
and end of life situations. A 2007University of Chicago study found that
some “14% of physicians surveyed believe it is acceptable to withhold
medical options they find morally objectionable and 29% would not refer
a patient for a procedure they object to.” Pharmacists are refusing to
fill prescriptions for birth control and refusing to offer emergency
contraception even when it is legal without a prescription. The proposed
sale of two Denver area hospitals to the Sisters of Charity of
Leavenworth Kansas has brought to public attention Catholic refusal as a
matter of policy to provide procedures such as tubal ligations or
vasectomies, and assistive procedures such as in vitro fertilization, in
addition to the refusal to provide contraception, emergency
contraception or abortion. Americans are increasingly cared for by
health care providers who are basing medical practice on their own
personal values. It has been estimated that ”40 to 100 million Americans
are being cared for by physicians who place their own views above the
needs of their patients.” Medical providers who withhold information on
treatment options and ignore patient preferences are not basing their
care on best medical practices.
There is a similar problem with the health care provided in the private
for profit world. For profit providers have no institutional reason to
withhold options or ignore patient preferences, unless, of course, they
don’t offer those procedures, but in our market economy the patient can
go elsewhere. Unless of course, you need or want care or a procedure
that you cannot afford even after applying your insurance, then the
problem is called access. You know there is care available but you don’t
have access to it. This is not best medical practice either.
In a Catholic hospital, medical care is subject to the 4th Edition of
the Ethical and Religious Directives for Catholic Health Care Services,
published in 2001 by the US Council of Catholic Bishops. These 72
Directives and the narrative accompanying them are very readable and
very informative of Catholic doctrine. You will note that the title is
not “the Medical Directives” but “the Ethical and Religious Directives.”
In the Catholic worldview, medicine is secondary to religion and the
highest medical authority in the diocese is the bishop. Importantly, the
Catholic Church may be the single largest provider of heath care in this
country if not in the world, and please understand that in many small US
communities the only institutional provider of medical care is the
Catholic Church. We should be grateful. Our society, our government, has
been very comfortable in acquiescing our responsibility to provide for
our citizens to an organization whose overarching purpose is not medical
care but salvation.
I’d like to illustrate how these Directives might hypothetically affect
any of us.
Suppose as a member of this congregation, Ms. S, has been considering
her own end of life concerns: she’s taking Adult RE classes, looking
into the Five Wishes, even consulting with lawyers to draft her own
advance medical directives. She becomes quite clear on her end of life
preferences. Yet if she has the bad luck to be involved in a freak
accident while driving on C-470, there is a very real possibility that
the EMS would take her to the closest hospital and that hospital might
easily be owned by a Catholic organization.
Suppose her fictional accident has left her in a state requiring that
her advance directives be consulted. In a Catholic hospital Ethical and
Religious Directive #24 would also be consulted. It states:
” In compliance with federal law, a Catholic heath care institution will
make available to patients information about their rights, under the
laws of their state, to make an advance directive for their medical
treatment. The institution, however, will not honor an advance directive
that is contrary to Catholic teaching. If the advance directive
conflicts with Catholic teaching, an explanation should be provided as
to why the directive cannot be honored.”
What advance directives might not be honored? As it turns out Ms. S’s
directives specifically state that if she is so ill that her return to a
good quality of life cannot be reasonably expected that she be allowed
to die and not be kept alive by artificial means or other life
prolonging procedures including nutrition and hydration. Her directives
also request that medication to alleviate hopeless pain be administered
even if doing so hastens her death. But Directive # 58 states:
"There should be a presumption in favor of providing nutrition and
hydration to all patients, including patients who require medically
assisted nutrition and hydration, as long as this is of sufficient
benefit to outweigh the burdens to the patient."
And #61 states,
“Patients should be kept as free of pain as possible so that they may
die comfortably and with dignity, and in the place where they wish to
die. Since a person has the right to prepare for his or her death while
fully conscious, he or she should not be deprived of consciousness
without a compelling reason. Medicines capable of alleviating or
suppressing pain may be given to a dying person, even if this therapy
may indirectly shorten the person's life so long as the intent is not to
hasten death. Patients experiencing suffering that cannot be alleviated
should be helped to appreciate the Christian understanding of redemptive
suffering."
Ms. S is a Unitarian Universalist; do you think it appropriate that she
be counseled to appreciate the Christian understanding of redemptive
suffering? What if Ms. S were also an atheist, or Muslim, or Bahai, or
Jewish, or Zuni?
I admire the logic of the Catholic Church. The consistency of Catholic
teaching and Catholic life is remarkably seamless and, as far as I can
tell, without contradictions. Assuming that you accept a supernatural
god and the view that mankind is inherently flawed, in need of
salvation, and that the goal of earthly life is eternal life in heaven,
then the Catholic Church has over the past two millennia resolved all
questions of how to live as a faithful Catholic. But we live in a
multifaceted society filled with people of many faiths who do not wish
to live as a faithful Catholic.
A word about the Religious Right. Unlike the Catholic Church which goes
about its business and publishes its doctrine honestly for all to
examine, evangelical Christian groups in this country prefer to work
behind the scenes. They seek to influence public policy by placing
members in regulatory agencies, raising media effective questions so as
to cast doubt on scientifically based medical practices, and reframing
their agenda in misleading terms (to be pro choice is to be against
women). Evangelical groups view health care as a tool to further their
goals.
These are the compelling reasons why we must change the basis for the
provision of medical care in the US. We have lost sight of the impact
that lack of care has on people’s abilities to rise out of poverty, to
participate in American society to the fullest, and to provide for their
future. Medical care must be offered free of religious restrictions and
the full range of care must be accessible to all citizens. Currently
care is offered as an option--not as a civil right. It is offered to
those who can afford it. It is offered to the faithful (and those
willing to at least temporarily accept that faith, for if you walk into
a Catholic hospital you will be treated as a member of that faith.) It
is offered to those willing to limit their choices in return for the
state charity we call Medicaid or in return for the reduced cost we
refer to as ‘covered by insurance.’ My guess is that most people in this
sanctuary today have elected to limit their potential medical care to
what they think they will be able to afford. We do not base medical care
upon medical need.
With all that as background, let’s move to what health care in the US
would look like if it were based on the ethics of liberal religion. RCRC
has identified 5 fundamental principles on which health care may be
based:
1. “That a right to health, derived from the inherent dignity of each
human being, justifies without qualification an individual’s expectation
of timely and adequate health care”
2. “That the central ethical and humane tradition of providing quality
health care to all must be maintained. This includes guaranteeing equal
access to medical services; honoring the right of medical professionals
to exercise their professional judgment in the best interests of their
patients; and recognizing the professional obligation of medical
providers to support access to medical care for all people in the
interest of the public good.
3. “That sectarian doctrine should never override the law or undermine
the ethical pillars of medicine that require doctors and other health
care providers to do no harm, to do positive good, to respect the
autonomy of persons, and to heed the principles of justice.
4. “That an individual’s conscience my guide his or her own behavior but
may not control or restrict the exercise of conscience in others.
5. “That the quality and availability of health care services for women
affect the health and well-being of their children and families so that
limitations to these services have a profound long-term effect on the
public’s health.”
If our health care system were built upon these principles, medical care
would be a civil right. Access to medical information and treatments
would be available to all regardless of income or geographic location.
Providers would base their recommendations on science, best medical
practice, and their patient’s needs. Differing religious beliefs would
be honored for both provider and patient through respectful referrals.
And reproductive and sexual health care would be based on the full range
of our human experience without prejudice. The Guidelines are
specifically developed for general healthcare, for providers and
institutions, for reproductive health care, for medical surrogates and
advance directives, for informed consent, and finally for the refusal to
provide care.
RCRC had two goals as their Guidelines were developed: that Americans
would use the Guidelines as a unifying document for advocating quality
health care, and that medical providers as individuals and as
organizations would use these guidelines “as a guide to providing
respectful and conscientious health care.” Consequently, I am providing
for each household represented here today a copy of the first sections
of the Guidelines. (The complete document is too long to provide, but I
have listed the appropriate websites for you to consult.) I hope that
you find this perspective useful during this election year as we examine
the proposals of candidates for public office and any proposed
initiatives or constitutional amendments we may be asked to vote on.
Personally, I have chosen to act on my faith by speaking publicly today
about the inequities in our health care system. I have chosen to walk
through my pharmacy and note where the condoms are kept. I’ve chosen to
ask my pharmacist what her/his position on Plan B contraception is. I
chose to discuss at my annual check-up whether my current medical
directives are appropriate and if they will be honored. I have not faced
what I will do if my health care insurance limits my treatment choices
or cannot support my advance directives because it limits my choice of
hospitals.
But I will continue to ask questions about how our system offers care. I
will ask my local and national representatives to craft health care
legislation that honors our constitutional guarantee of freedom of
religion, for as the Guidelines point out that freedom means ”both
freedom for religion and freedom from religion.” I will ask my local and
national representatives why health care is an economic privilege and
not a civic right.
The similarity between our faith and democracy is real and historic.
Both rest on the assumption, the belief, that the voice of the people,
as argumentative and messy as that voice can be, is the only authority.
“We the people” our forefathers said and overthrew an empire. It is time
for “We the People” to determine how we will provide Justice, Equity and
Compassion in health care AND in human relations.
Thank you for listening today.
For more information and to read referenced documents in their entirety
please go to:
www.rcrc.org
www.rcrc.org/pdf/ingoodconscience.pdf
www.rcrc.org/pdf/medicalright_fullreport.pdf
www.usccb.org/bishops/directives.shtml
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