In these pages,
I recently
argued that Catholics and others must not comply with the United States
Department of Health and Human Services’ (HHS) mandate requiring virtually all
employers to provide health insurance to their employees that would cover
direct sterilization and contraceptive drugs and devices, including those which
may cause abortions. The discussion there focused primarily on a defense of
conscience and religious liberty. Here I would like to explain further why, as
a matter of a well-formed conscience, Catholics must not compromise the demands
of the moral law and their own faith by obeying the mandate.
The US bishops’ witness to moral truth
In its
most recent statement on this matter, the United States Conference of
Catholic Bishops (USCCB) gave several examples, including the HHS mandate, in
which religious liberty is currently under attack in our society, and spoke prophetically
about the need to defend this most cherished freedom. The bishops rightly state
that the mandate amounts to an unjust law, which has no moral authority because
it forces “religious institutions to facilitate and fund a product contrary to
their own moral teaching and purport[s] to define which religious institutions
are ‘religious enough’ to merit protection of their religious liberty.” They
underline the obligation not to obey an unjust law in the strongest of terms:
It
is a sobering thing to contemplate our government enacting an unjust law. An
unjust law cannot be obeyed. In the face of an unjust law, an accommodation is
not to be sought, especially by resorting to equivocal words and deceptive
practices. If we face today the prospect of unjust laws, then Catholics in
America, in solidarity with our fellow citizens, must have the courage not to
obey them. No American desires this. No Catholic welcomes it. But if it should
fall upon us, we must discharge it as a duty of citizenship and an obligation
of faith.
Promoting the common good
The bishops,
however, are not simply adopting a defensive posture. They wisely understand
that protecting conscience and religious liberty is foundational to allowing
the demands of faith to generate and undergird the Catholic contribution to the
common good. As one example of the importance religious witness has to society
the bishops recall the civil rights movement: “During the civil rights movement
of the 1950s and 1960s, Americans shone the light of the Gospel on a dark
history of slavery, segregation, and racial bigotry. The civil rights movement
was an essentially religious movement, a call to awaken consciences, not only
an appeal to the Constitution of America to honor its heritage of liberty.”
Opposing the
immoral demands of the mandate is likewise an opportunity for Catholics to give
prophetic witness to the evil practices which they and others cannot in good
conscience promote. The Catholic Church opposes direct sterilization, and the
use of contraceptive drugs and devices, including those which may cause
abortion, not as a matter of “company policy,” but as a matter of moral
conviction that these practices violate the true dignity of the human person.
One cannot promote the true good of individuals and society by facilitating and
promoting practices that are, in fact, injurious to persons.
A call to prophetic witness
The bishops
conclude their statement on religious liberty by calling upon Catholic
laypersons, politicians, those working in education, health care, and social
service ministries, and priests and religious to undertake the important work
of protecting conscience and religious liberty rights. They appeal to their
brother bishops to “exhort each other with fraternal charity to be bold, clear,
and insistent in warning against threats to the rights of our people. Let us be
the ‘conscience of the state.’”
No room for compromise
Although the bishops
do not take up the question of cooperation, they do indicate that there would
be no moral justification for obeying the mandate. In fact, they speak of
having the courage not to obey unjust laws, under which heading they place the
mandate. I think the bishops are absolutely correct in stating that there can
be no compromise on the part of Catholics in this matter. This is so because, depending
on the employer’s acceptance or rejection of the immoral practices in question,
compliance with the mandate would constitute either formal or immediate
material cooperation. The former is never morally permissible and the latter is
not permissible in the matter of the mandate.
The principle of cooperation
The principle of cooperation (POC) is used to evaluate the
morality of a secondary agent’s actions that in some way contribute to the
immoral acts of a primary agent. Since a basic principle of Catholic moral
teaching is that evil cannot be done for any reason, including the pursuit of
good, the POC could never justify a secondary agent’s agreement with the evil
intended by the primary agent. The primary and secondary agents’ intentions, it
should be noted, are present in both what they do and in the motive for which they do it.
Although evil can never be directly intended, the Catholic moral
tradition has recognized that evil may sometimes be indirectly intended; that is,
tolerated. Both the principle of double effect and the principle of cooperation
address situations in which the pursuit of some good may well involve the
toleration of evil. However, moral agents must be truly reluctant to do
something that requires the toleration of evil. Obviously, neither principle
should be employed as a method to rationalize participation in evil.
The POC addresses situations in which a secondary agent’s pursuit of some good
necessitates the toleration of the evil done by the primary agent. It assists
the secondary agent in evaluating his participation in evil by identifying the
conditions that make cooperation morally justifiable. These conditions are
revealed by answering a series of questions. Is it necessary to pursue this
good here and now if it involves cooperation in evil? Do the circumstances make
it clear that the evil is only tolerated? Is the good that is pursued
proportionate to the evil that is tolerated? Will cooperation with evil be
scandalous in the sense that it would contribute to the spreading of evil, by
making evil actions seem less evil, and leading others to accept, perform, and
even promote those same actions?
By answering such questions, one is able
to distinguish cooperation that is the same as doing evil from cooperation that
demonstrates a toleration of evil necessitated by an obligation to pursue some
proportionate good that cannot otherwise be reasonably achieved. If the
secondary agent claims to be pursuing some necessary good and only tolerating
the evil the primary agent is engaged in, then the POC assesses the validity of this claim. It does
so by examining the secondary agent’s intention as it is found in what he
does (object of the act) and in why he does it (motive), in light of all
the relevant circumstances in which the act takes place. Regarding what the
agent does, the POC asks if the
cooperation is necessary to the primary agent’s action, or whether it helps in
some material but non-essential way. Regarding why the secondary agent
cooperates, the POC asks if there is any obligation to pursue the good and if
the good pursued is proportionate to the evil tolerated.
Since evil can never be directly
intended, the will of the secondary agent can never be in agreement with the
evil will of the primary agent. This level of cooperation is called formal and is always
forbidden. Such formal agreement with the immoral will of the primary agent is explicit
when the secondary agent makes no claim to the contrary. It is implicit when,
even if he claims otherwise, no other plausible explanation can be given for
his level of participation in the primary agent’s evil action.
Still there may be circumstances in
which a secondary agent’s cooperation, though essential to the evil act, is
provided despite his opposition to the evil will of the primary agent. For
example, an anesthesiologist who would never choose to assist with a direct
abortion provides anesthesia to a pregnant woman who is undergoing surgery for
injuries sustained in an automobile accident. During the course of the
operation, the surgeon decides that the woman’s chances for survival would be improved
if he aborts the fetus. There are no other anesthesiologists available and the
attending anesthesiologist has no alternative but to continue participating in
the operation. His cooperation in the immoral act of the surgeon is necessary,
yet his claim not to agree with the evil will of the primary agent is made
credible by the duress under which he is made to cooperate. This is called immediate
material cooperation, which may be permissible in such rare circumstances
as those described here.
When the secondary agent’s will is not in agreement with the evil
intention of the primary agent and his cooperation is not essential to the evil
act, the cooperation is mediate and material. He cooperates in
this fashion because of some good that he is obligated to pursue and cannot
otherwise reasonably attain. Theologians have introduced two additional
refinements to test the credibility of the secondary agent’s claim not to agree
with the evil intention of the primary agent. These deal with the physical and
causal relationship of the secondary agent’s action to the evil action itself.
The closer the secondary agent is to the immoral act of the primary agent, the
more compelling must be his reasons for cooperating. This is the basis for the
distinction between remote mediate material cooperation and proximate
mediate material cooperation. The tradition has allowed for mediate
material cooperation (proximate or remote) when the good at stake is
proportionate to the evil tolerated and every effort is made to avoid giving
scandal. When scandal is likely then even mediate material cooperation is
impermissible.
CDF and
institutionalized cooperation with evil
Several years ago,
Catholic health care providers tried to justify permitting direct
sterilizations in Catholic hospitals. They appealed to the principle of cooperation
and claimed that their cooperation was justified by duress (e.g., the threat of
losing ob-gyn physicians, resulting in the need to close the entire obstetrics
department, with the consequent loss of revenues needed to keep the hospital
afloat). The Congregation for the Doctrine of the Faith (CDF) rejected this
claim by pointing out that permitting direct sterilization in these circumstances
would force these Catholic institutions routinely to allow direct
sterilizations, thereby institutionalizing the practice.[1]
The CDF’s judgment highlights the fact that even if duress may in a particular
situation justify a particular instance of immediate material cooperation,
ongoing duress could not justify regularizing such cooperation. Moreover, the
institutionalization of cooperation with direct sterilization would be truly
scandalous, which is a further reason for which it cannot be justified.
The HHS mandate and private employers
Although the US bishops’
opposition to the mandate has focused primarily on its effect on Catholic
institutions, they are also deeply concerned about its effect on individual
employers. A Catholic employer who in conscience opposes direct sterilization,
and contraceptive drugs and devices, including those which may cause abortions,
but nevertheless provides the insurance coverage because of a government
mandate, would be an immediate material cooperator in these same evil practices.
The HHS mandate would force such employers to provide this coverage on an
ongoing basis, thereby requiring them to regularize their immediate material
cooperation with evil. For this reason, and the fact that it would be truly
scandalous, their cooperation could never be justifiable.
Obeying the mandate and paying taxes
While there are
some similarities between providing coverage for these immoral practices and
paying taxes, which are then used by the government to fund some immoral
practices, there are some important differences. The HHS mandate requires
employers to provide coverage specifically
for immoral practices, which they had previously been exempt from doing. The very
purpose of the mandate is to provide insurance for contraception, etc. That
being the case, to purchase such insurance for one’s employees, even as part of
a policy that covers many truly good health care services, is to deliberately pay
for drugs and procedures which are violations of the moral law, and their own
consciences. This is not the same thing as paying taxes which go into a general
fund from which the government takes money to pay for all its projects,
including some that are immoral. Citizens are not asked to pay taxes (or
perhaps even more in taxes) specifically for immoral practices. And no
religious body is asked, as a matter of policy, explicitly to fund immoral
practices in violation of its held beliefs.
We are all obliged
to pay taxes and have never exercised much control over how our tax dollars are
used, although we have had some success in curtailing tax-funded direct
abortion. However, the Patient Protection and Affordable Care Act (Obamacare),
including the provisions of the HHS mandate, can be avoided by not providing
health insurance for one’s employees and paying a $2,000 per employee annual
fine for violating this law. (On this point, it has been noted that some
employers may be inclined to drop health insurance for their employees as a
means of saving money. It would be far less costly for employers to pay the
fines than to purchase the insurance.) By paying taxes, we are all engaged in
justifiable remote mediate material cooperation with the evil actions
undertaken by our government. But obedience to the mandate would constitute
unjustifiable immediate material cooperation.
Catholic teaching and employee benefits
Although Catholic
social teaching encourages providing health insurance coverage, it assumes that
the insurance would address the true health care needs of employees and that it
would be delivered in a morally upright way. Direct sterilization and
contraception are not health care since they are directly aimed at either impeding
or destroying the proper function of a healthy reproductive system. There can
be no moral obligation to pay for harmful drugs and procedures which violate
the dignity of the human person. This fact would perhaps be more readily
grasped if our government demanded employers to provide coverage for direct abortion
and euthanasia, as it may yet do. If we can justify cooperation with direct
sterilization and contraception, on what basis would we refuse to cooperate
with direct abortion and euthanasia?
Conclusion
The HHS mandate
represents a serious attack on conscience and religious liberty. In this article,
I have argued that individuals and institutions must be free from governmental
interference in following the morally sound demands of their consciences and in
making their particular contribution to the common good. In conclusion, I would
like to make three points: First, providing health insurance coverage for
immoral practices cannot be justified whether it involves formal or immediate
material cooperation. Although it is true that an employer who buckles under
the demands of the mandate would not be culpable
for his cooperation if he lacked full consent of the will, his cooperation
would still be objectively evil and unjustified. Second, the ideal resolution
to the violations of conscience and religious liberty that the HHS mandate
places on Catholics and others would be to withdraw the mandate. Third, if the
mandate is not withdrawn, the response on the part of Catholic institutions and
private employers should be non-compliance. There is no moral obligation to
obey an unjust law or regulation and every obligation to resist it insofar as
possible. Disobeying the mandate may require employers to drop health care
coverage for their employees and pay the fine for doing so. As regrettable as
the loss of such coverage would be, it would be more tragic to force employers
to pay for these immoral practices.
As Bishop Daniel
Jenky of Peoria recently
said during a homily at a Catholic men’s conference:
As
Christians we must love our enemies and pray for those who persecute us, but as
Christians we must also stand up for what we believe and always be ready to
fight for the Faith. The days in which we live now require heroic Catholicism,
not casual Catholicism. We can no longer be Catholics by accident, but instead
be Catholics by conviction. In our own families, in our parishes, where we live
and where we worklike that very first apostolic generationwe must be bold
witnesses to the Lordship of Jesus Christ. We must be a fearless army of
Catholic men, ready to give everything we have for the Lord, who gave
everything for our salvation.
The principle of cooperation was never intended as a
tool to rationalize the promotion of evil. We must not look for “loopholes” in
Catholic moral teaching to excuse ourselves from the prophetic witness that
this moment demands. Cooperation is not an option.