Tag Archives: Marie T. Hilliard

Who lives, who dies, who decides?

Marie Hilliard: People who want a ‘perfect life’ will even kill children . . .

Marie T. Hilliard

Marie T. Hilliard

We live in a culture that perpetuates the myth that we can have a perfect life. Baby Boomers embraced the fable that they can control everything, including life and death. After all, technology has provided such great advances that children can be engendered on demand.

If less than perfect offspring are identified before birth, they can be eliminated. In the Netherlands, parents have the option of “after birth abortion” — also known as murder or infanticide. This has evolved into a cultural mindset that deems less-than-“perfect” persons — such as those with disabilities and the elderly with dementia — as unfit to live, or at least unworthy to have equitable access to health care resources.

As we witness the generation that embraced abortion-on-demand advancing in age, will this generation now be the subject of the next generation’s similar approach to the frail or disabled elderly?

As faith is being driven out of the public square, the concept that suffering can have meaning is increasingly alien to our culture. Many of us remember being formed by faithful nuns. They showed us how suffering can have meaning when united to the cross. How often did we hear, “Offer it up” — especially for the poor souls in Purgatory?

We live in a culture that only accepts the redemption that is falsely depicted as a perfect life in this world. Public policy makers, including elected officials, are merely products of our culture whom we’ve empowered to represent us in the public square; and as these polices unfold, there is growing evidence that the only acceptable way to deal with suffering is to abandon or eradicate the sufferer.

The evidence is everywhere. Studies demonstrate that in vitro fertilization (IVF) is being used by some parents to accomplish preimplantation genetic diagnosis on their very own offspring. A recent study indicates that 42% of the centers that engage in such lethal procedures will do so for sex selection. This move toward designer babies is a clear indication of a eugenic mentality, where only the flawless are allowed to live. No one can ignore the changing attitudes on how we treat the frail elderly and persons with disabilities.

Three states have legalized physician-assisted suicide (PAS): Oregon, Washington and Vermont. Montana decriminalized it through court order. The frightening fact is that there is a trend progressing toward active euthanasia, which is the case in the Netherlands. And if one looks at the statistics from Oregon, the data give great pause. Despite the fact that Oregon law mandates that a physician require a psychological evaluation of a patient if there is any question of whether a mental health condition may be causing the person to want to die, of the 673 persons assisted to die, only 42 were referred for such an evaluation.

What person wanting to end their life is not experiencing a treatable depression that could be alleviated if someone merely accompanied them in their suffering? Furthermore, Oregon law will not allow family members to be told of the request without explicit consent, nor allow the death certificate to list anything other than the underlying pathology as the cause of death. Thus, the frail elderly and disabled may easily be convinced by an exhausted or greedy family member that to kill oneself might be in everyone’s best interests.

Then enter the government with its own eugenic version of health care reform. The Affordable Care Act (ObamaCare) supports programs that provide abortion-on-demand and requires employers to provide employees with contraceptive and abortifacient drugs. It also penalizes health care providers who, in caring for the elderly and disabled, are costing the government too much money. There are penalties for hospital readmissions for the same diagnosis within a 30-day period. There is a 15-member Medicare Advisory Panel which will determine reimbursement polices on cost effectiveness.

The evidence is clear: Social policy is dictating who is worthy to be accompanied in their suffering and who is to be eliminated as too great a burden to our society. This is heralding a whole new approach to the sufferer and with it the denigration of our humanity. As Pope Benedict XVI wrote in Spe Salvi : “The true measure of humanity is essentially determined in relationship to suffering and to the sufferer. This holds true both for the individual and for society. A society unable to accept its suffering members and incapable of helping to share their suffering and to bear it inwardly through compassion is a cruel and inhuman society” (II, 38).

If we do not accompany the sufferer, and even worse, if we eliminate him from our midst, we have become a cruel and inhumane society.

MARIE T. HILLIARD, JCL, PhD, RN, is a staff ethicist at the National Catholic Bioethics Center.

With liberty and justice for some?

Marie Hilliard contends that the HHS mandate is unfair and unconstitutional . . .

Marie T. Hilliard

With the economy in the doldrums, times are difficult enough for businesspeople. Americans now have to decide whether to violate their consciences or a federal law. If left unabated, these dilemmas will continue — even if the U.S. Supreme Court rules that the Patient Protection and Affordable Care Act is unconstitutional.

In a social system that is increasingly hostile to our free market heritage, hostility is also growing toward the Catholic Church. When seeking to insert faith-based values into public policy debates, Catholics often are accused of violating the separation of church and state. Nothing could be further from the truth. “The most significant aspect of the separation of church and state is not, as some seem to think, the shielding of the secular world from too strong a religious influence,” according to Yale constitutional law scholar Stephen Carter. “The principal task … is to secure religious freedom.”

During his 2010 visit to the United Kingdom, Pope Benedict XVI spoke of St. Thomas More’s integrity in following his conscience. “Each generation, as it seeks to advance the common good, must ask anew: What are the requirements that governments may reasonably impose upon citizens, and how far do they extend?

“There are those who would advocate that the voice of religion be silenced, or at least relegated to the purely private sphere….And there are those who argue — paradoxically with the intention of eliminating discrimination — that Christians in public roles should be required at times to act against their conscience. These are worrying signs of a failure to appreciate not only the rights of believers to freedom of conscience and freedom of religion, but also the legitimate role of religion in the public square.”

This has been seen blatantly in the U.S. Department of Health and Human Services (HHS) mandate that the employers provide — at no cost to their employees — contraception, sterilization, and abortion-inducing drugs and devices. Furthermore, religious or faith-based ministries may be exempted only if they evangelize, employ and provide services primarily to their own members. Only three states with laws mandating such employee prescriptive coverage define a religious agency as narrowly as the HHS mandate: Oregon, New York and California.

However, state laws do not impact self-insured plans under the Employee Retirement Income Security Act, under which many Catholic dioceses are regulated. The HHS mandate will negate this protection. It’s clearly disingenuous for the federal government to state that it’s mimicking state laws already in existence. Clearly our Gospel-mandated ministries are under attack.

But what about the private employer? Shouldn’t they also have conscience protection under the law? Of course! That’s why it’s so appropriate that Legatus has filed a lawsuit against the HHS mandate, reflecting the need to protect businesspeople from HHS’s violation of religious liberty. (Click here for related story) Yet attacks against the consciences of private employers, employees, and businesses existed before there was an HHS mandate — and they continue.

A fertility practice that limited its practice to married couples was ordered by the California Supreme Court in 2008 to provide service to lesbians despite the physicians’ religious objections. In New York, a nurse was forced in 2009 to assist in a not-immediately-life-threatening abortion after having given all the appropriate notice of such objections. Her supervisor threatened her with actions against her nursing license. The court determined that the nurse had no right of private action against her employer.

Twenty-five states have passed legal mandates requiring pharmacies to provide emergency contraception to customers. Fortunately, brave pharmacy owners in Washington stepped up to the plate to challenge this injustice. The courts recently reversed the position of the Washington State Board of Pharmacy after the Becket Fund, representing the pharmacists, got the Board’s anti-conscience position reversed. However, the state’s attorney general is appealing the decision.

Where is Thomas Jefferson when we need him? “Our rules can have authority over such natural rights only as we have submitted to them. The rights of conscience we never submitted, we could not submit. We are answerable for them to our God.”

All of us — particularly lay people — need to echo this assertion: “We cannot submit; we will not submit. Our conscience is answerable not to the state, but to God.” We cannot accept that there be liberty and justice only for some. Persons of faith can lay claim to the “first right” guaranteed by the First Amendment of the U.S. Constitution — the right to religious liberty. We can and we must.

Marie T. Hilliard, JCL, PhD, RN, is a staff ethicist at the National Catholic Bioethics Center.

The erosion of religious liberty in America

Catholics must bring the reasoning of natural moral law to the public policy debates . . .

Dr. Marie T. Hilliard

We the lay faithful, according to the Second Vatican Council, are called to live in the world and make it holy. However, we are increasingly reminded that this is no small task. A culture, once respectful of our First Amendment right to the free exercise of religion, is now accusing us of violating the principle of separation of church and state.

However, nothing could be further from the truth, as the Yale constitutional law scholar Stephen Carter said in his 1993 book The Culture of Disbelief: “For the most significant aspect of the separation of church and state is not, as some seem to think, the shielding of the secular world from too strong a religious influence; the principal task of the separation of church and state is to secure religious freedom.”

There is strong evidence of an escalating attack on the right to religious freedom. With the legal recognition of same-sex unions in 18 states and the District of Columbia, the right of persons of faith not to be forced to recognize such unions is being violated. An Oregon clerk was fired in 2008 for refusing on religious grounds to issue certificates of registered domestic partnership to applicants. Fortunately, she successfully challenged this action in court. A fertility practice that on religious grounds limited its practice to married couples was ordered by the California Supreme Court to provide this service to lesbians in 2008. A New York nurse was forced to assist in a not-immediately-life-threatening abortion in 2009, after having given all the appropriate notice of such objections even in her job interview.

The American College of Obstetricians and Gynecologists has stated that physicians of conscience not only must refer to other providers of morally illicit procedures, but in resource-poor areas locate their practices in proximity for such referrals to occur, and in an emergency violate conscience in the providing of such a morally illicit procedure.

With the enactment of the Patient Protection and Affordable Care Act (also known as ObamaCare, but herein referred to as the Act), the need to protect religious liberty is never so evident. It’s undeniable that the Act not only funds programs that will provide elective abortions, but also likely provides for the direct funding of elective abortions through other programs. The Act mandates that “essential health benefits” be provided in every region of the country. Courts have construed such Medicaid provisions to include abortion. Thus, any federal health care legislation must specifically invoke the Hyde Amendment on all options within the bill to assure its applicability, which the Act does not.

There are only two provisions within the Act that protect the conscience and religious liberty of health care providers: opt-outs for participating in assisted suicide and abortion. The problem is in the definition of such terms. Preventing the implantation of a conceived human being is no longer considered abortion. Furthermore, states which have legalized assisted suicide specify that actions taken in accordance with such laws do not constitute suicide, mercy killing or homicide under the law. Thus, without the Hyde/Weldon Conscience Protection Amendment, which is missing from the Act, any conscience protection is tenuous at best.

This scenario becomes more ominous with the recent rescinding of the major protections of the 2008 conscience rule (2008 Final Rule). The 2011 Final Rule limits its examples of conscience protections to sterilizations and abortions. Now there is an effort to mandate that “preventive services” referenced in the Act include contraceptive drugs and devices, which would include abortifacients.

Yet, we have heard that there is “no need to be concerned” because existing laws will protect health care providers of conscience. The facts betray such a statement. Only 10 of the 25 states with pharmacist mandates in the dispensing of emergency contraception provide true conscience protections, and four of these 25 states require a pharmacist to fill all legal prescriptions. Even the Religious Coalition for Reproductive Choice admonishes that the law should not be overridden by positions of conscience that are based in religious beliefs.

Where is Thomas Jefferson when we need him? “Our rules can have authority over such natural rights only as we have submitted to them. The rights of conscience we never submitted, we could not submit. We are answerable for them to our God.”

Our voices cannot, must not, be silenced. We are not speaking of the individual right to endorse political parties or candidates, but to make clear the need for applying the reasoning of natural moral law to the public policy debates.

Natural moral law is the foundation of a just society. It can be known by reason, and no institution has a better understanding of it than the Catholic Church. We, its lay faithful, must bring that voice of reason into the public sphere. There has never been such a need for those voices to be heard.

Marie T. Hilliard, JCL, PhD, R.N., is a staff ethicist at the National Catholic Bioethics Center.

Caring for victims of sexual assault

Dr. Marie Hilliard discusses the Catholic ethical position on caring for rape victims . . .

Dr. Marie T. Hilliard

Dr. Marie T. Hilliard

Historically, those subject to the canonical penalty of a latae sententiae excommunication for abortion were the doctor and woman who consented to the surgical procedure — and those who cooperated with it by either causing the abortion to happen (a coercing parent or boyfriend) or making it possible (the anesthesiologist).

With the advent of drugs which induce non-surgical abortions, the Pontifical Council for Legislative Texts clarified in 1988 that abortion includes the destruction of the embryo or fetus any time after conception. Thus, the health care professionals who prescribe, dispense or administer interceptives — which interfere with the embryo before implantation (intrauterine devices and the “morning-after pills”) or contragestatives which eliminate the implanted embryo (RU-486) — also would be subject to canonical penalties if there is certainty that a completed abortion has resulted and the conditions for such penalties were present.

The use of Plan B or any other “morning after pill” for the purpose of avoiding conception following consensual sex is contraceptive in nature and is rejected by the Church. Many Catholics are surprised to discover that sexual assault is another matter. The issue of sexual assault is not addressed in the Vatican’s new bioethical document, Dignitas Personae, so sound moral reasoning has to be used to determine which protocol is morally acceptable for the administration of emergency contraceptive drugs. The U.S. Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services (ERD) states:

“A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction or interference with the implantation of a fertilized ovum” (#36).

Thus, it would be moral to administer medications to prevent conception from a sexual assault. The question remains: What protocol would be moral in accomplishing this good without endangering the life of the potentially conceived embryo?

The primary action of the Plan B “morning-after pill” (sometimes referred to as emergency contraception or EC) is anovulatory. It suppresses ovulation — the release of the woman’s ovum — preventing the engendering of an embryo. However, depending on when the medication is administered, Plan B also may prevent the implantation of a conceived embryo in the uterus, thus acting as an interceptive.

Dignitas Personae states that “scientific studies indicate that the effect of inhibiting implantation is certainly present, even if this does not mean that such interceptives cause an abortion every time they are used, also because conception does not occur after every act of sexual intercourse” (#23).

Some hold that EC may never be administered to a victim of sexual assault unless one definitively could determine the day of the victim’s reproductive cycle. They cite research indicating that it does not always prevent ovulation, but if administered during or around the time of ovulation, precipitates a disruption in the complex mechanisms of the endometrium, negatively impacting the implantation of any conceived embryo.

Others hold that before the administration of EC, all that is morally required is a negative pregnancy test. However, pregnancy test results become accurate only after implantation, about 10-14 days after ovulation. A pregnancy test performed within 72 hours after the assault (the optimal time period for effective EC administration) cannot indicate whether conception has or will result from the assault. These proponents cite research indicating that EC will not disrupt or harm an implanted embryo, and studies indicating that any effect on the endometrium is insufficient to prevent implantation. However, there is credible research to the contrary.

The National Catholic Bioethics Center holds that administration of EC must be consistent with ERD (#36) —to “prevent ovulation, sperm capacitation or fertilization.” Current research indicates that the impact of EC on sperm capacitation is not fast enough to prevent fertilization. Therefore, the only reason for which EC morally can be given is to prevent ovulation. The key is to have as much medical certainty as possible that ovulation can be prevented in the particular patient in question. EC alone is unable to prevent ovulation once the surge of luteinizing hormone (LH) stimulates ovulation and the pregnancy-test-only protocol does not tell us whether this surge has begun.

Adding an ovulation (LH) test to the protocol indicates whether ovulation is occurring or imminent. With a positive ovulation test, one may conclude that EC will not prevent ovulation and that conception likely could take place with the potential for the disruption of embryo implantation. Some would go further and argue for a serum progesterone test, which would determine the pre- or post-ovulation day more accurately. However, equipment for such testing is not readily available in many emergency rooms.

Furthermore, if undetected “breakthrough” ovulation does occur, despite the administration of EC in the presence of a negative LH test result, the conditions for the moral administration of EC under the principle of double effect would have been met. Any minimal potential for harm would be an unintended consequence of the legitimate desire to suppress ovulation.

Marie T. Hilliard, JCL, PhD, R.N., is a staff ethicist at the National Catholic Bioethics Center.