Religious Freedom in Healthcare

It’s great to see all of you. Thank you for coming, thank you for being here for this presentation.

I know that there are some other wonderful presentations going on today, so I’m just really grateful for your time. Hopefully, you’ll find this very fruitful, encouraging, and it will provide the desire—the motivation—for us to go forth and defend our brothers and sisters in the healthcare profession.

So thank you very much for being here.

Before we begin in prayer, I’ll just introduce myself. My name is Andrew Kubic. I work at the Religious Freedom Institute in Washington, D.C. I’m the Deputy Director of our National Center for Religious Freedom Education, and I’m also Research Fellow in Bioethics and Medical Conscience. I also have the joy—another hat I wear—to work at the National Catholic Bioethics Center. I have the privilege to do that.

We have Joseph Mey here today, and there I serve as a personal consultations ethicist.

So let us begin in prayer. If you don’t mind, you’re welcome to. I included a QR code that’ll take you directly to the book of Deuteronomy, as you see here, Chapter 30, and I thought we can pray through Scripture today.

If you wouldn’t mind joining me.

In the name of the Father, and of the Son, and of the Holy Spirit. Amen.

“See, I have today set before you life and good, death and evil. If you obey the commandments of the Lord your God, which I am giving you today, loving the Lord your God and walking in his ways and keeping his commandments, statutes, and ordinances, you will live and grow numerous, and the Lord your God will bless you in the land you are entering to possess. If, however, your hearts turn away and you do not obey, but are led astray and bow down to other gods and serve them, I tell you today that you will certainly perish. You will not have a long life on the land which you are crossing the Jordan to enter and possess. I call heaven and earth today to witness against you: I have set before you life and death, the blessing and the curse. Choose life then, that you and your descendants may live.”

Almighty God, we are grateful first and foremost for you, for your beloved Son, our Lord and Savior Jesus Christ, who makes himself present every day, every moment in the Eucharist—the nourishment, the medicine we all need in a very hungry and sick world.

We ask you to shine down your blessings upon us, to give us the courage to walk in your ways, to keep your commandments, and to follow you until you call us home.

Also, Lord, give us today the courage to stand united with absolute resolve to protect the conscience rights of our healthcare professionals, of our medical students, and of our religious institutions.

We ask all of this in the name of Jesus Christ, Our Lord. Amen.

In the name of the Father, and of the Son, and of the Holy Spirit. Amen.

The Mission of the Religious Freedom Institute

So I will have a few plugs, if you don’t mind, for the Religious Freedom Institute. But I have a lot to be proud of, and where we see education and our religious freedom and healthcare initiatives blend together is where we resolve—where we work to teach individuals what conscience is, what religion is, its importance in society, and how to defend it.

It’s incredibly important. I don’t have to go through case studies or news articles for you to know the dangers that are occurring today, the persecutions that are occurring today, across all walks of life but including in healthcare, where those who serve us are looking for people to serve them.

The Three E’s of Religious Freedom

So the Religious Freedom Institute, through the lens of education, through giving the words, the truths, the ideas to all of those in attendance, to all those who are looking to receive—we define religious freedom and we explain it according to what I like to cleverly say are the three E’s: to explore, to embrace, and to express.

It’s very important to especially emphasize that last one in our world today, as we see religious freedom being persecuted more and more.

We’re starting to hear—and I think we’ve been hearing it for some time—but we’re hearing more and more an emphasis on:

• “Well, you’re free to believe whatever you want, but don’t practice it. Don’t bring it to the public square. Don’t bring it to your profession.”

But to explore, to embrace, and to express is fundamental to the right understanding of what religious freedom is.

So I want you to walk away with those three E’s. Think about them, pray about them, discuss them with others. I think it’s a simple, clever, yet very understandable way to understand what it means to be free—to search for truth, to embrace it, and then to live it.

Explore: Rooted in Human Nature

One of the things I really appreciate about the three E’s is that we find them rooted in Catholic Church teaching and rooted in natural law.

I could do this presentation—I’ll probably take out some of the slides on the Catechism—but I can do the three E’s in a room full of our non-Catholic Christian brothers and sisters, as well as people of other faiths, because to explore, embrace, and express is a deeply human endeavor.

That could be my fourth E: human.

To look at explore, I turn to St. Thomas Aquinas. We’re so blessed to see so many of our Dominican friars as well as religious sisters here, walking the grounds, participating in the conference.

Thomas Aquinas wrote in his great work on theology that man has a natural inclination to know the truth.

In other words, when St. Thomas Aquinas, the Angelic Doctor, was revealing to us the difference—the distinctions—between animals and man, he said certainly there are some things they hold in common. But there are some things that are exclusively written on the heart, authored by God in man.

And we are hardwired, we are designed, we are authored to seek out truth in our life. That is a matter of human dignity.

Embrace: Restlessness of the Heart

Now, where that truth leads—we know people, I’m sure, of all different faiths. We might know people of no faith. But nevertheless, we ought never to say that we are not all searching for something. And I would say, searching for Someone.

Thomas Aquinas tells us again: man has a natural inclination to know the truth about God.

To explore I kept going back to Confessions from St. Augustine, and his commonly repeated, incredibly well-known phrase:

“Restless is our heart until it comes to rest in Thee.”

Consider that for a moment in light of religious freedom. To deny religious freedom is to force upon somebody a restlessness. It’s to take the comfort, the joy, the love, the satisfaction, the motivation that comes with embracing our Christian faith.

And by not allowing that to be expressed in someone’s profession, we are forcing upon someone a restless heart. A very uncharitable act.

But restless is our heart until it comes to rest in Thee.

Express: Faith in Action

And finally, to express. If you have not read Dignitatis Humanae yet, I highly recommend you read this great work, promulgated by Pope Paul VI, coming from our Second Vatican Council.

There I found a fantastic, brief explanation for express. It even has it in the phrase: the social nature of man.

What it means to participate in society requires that he should give external expression to his internal acts of religion.

It’s so important. It’s necessary. It’s foundational. To believe—but our faith is a faith of action. We are not supposed to sit idly by on the medicine of the world that it desperately needs. We are to bring it to the world.

To express one’s faith, I would argue—and I hope you do too—is an absolute necessity for a society that truly understands and truly protects religious freedom.

Defining Religious Freedom at RFI

At the Religious Freedom Institute, we have a rather novel definition, but one that I think all of you could certainly read and embrace. Nevertheless, there are four characteristics to religious freedom as we define it at RFI.

If you want to take a picture—and by the way, if you want any of these slides, please feel free to reach out, my information is on the last one. But I want to call your attention to the last two, kind of bolded and underlined. I don’t know how else to make it stand out, so I’ll read it:

Religious freedom means to live publicly according to religious truth and to express beliefs freely in civil society and political life.

Let no one tell you, let no one tell your friends who are doctors, who are in medicine, nurse practitioners, our physicians, our assistants, our beloved nurses, that their faith stops at the door to the clinic. They are called to bring their faith—to have it inform their actions in the exercise of such a noble profession.

Natural Law: Foundations for Conscience

When we think about natural law—and I’m sure we’re all very familiar with it—thinking about St. Thomas Aquinas, who we’ll allude to in this third part here. But when we think about natural law, we actually go back to the great Apostle of the Gentiles. We go to St. Paul himself, who wrote in Romans:

“The Gentiles show that the demands of the law are written in their hearts.”

He didn’t simply say that there is a law, but the demands of the law. The law God has written on our hearts so we may live well and flourish must be lived out. There are demands to it. There are actions necessary.

So what are the effects of a society, what are the effects of a state or federal government, what are the effects of professional organizations when we refuse the freedom—refuse the freedom, turn a blind eye to something that does not come from man but comes from God?

What are the effects of that on the hearts of our healthcare professionals? And what are the effects of that on the hearts of the patients whom they serve?

In Psalms we hear: “Turn from evil and do good.”

Action. You’ll notice I keep emphasizing this term, because the expression of religion is what we’re really talking about here—being able to freely express.

Turn from evil—not just discern from evil, even though that’s implicit—but turn from it, act, move away from that which is against the dignity of the human person, against the reality of human sexuality. Turn away from those and protect them.

And then finally, St. Thomas Aquinas—going back to our Angelic Doctor. He wrote in his Summa Theologiae that within the natural law the first principle is: we all seek the good.

And then he goes on to say the first precept, what follows from that, is that we do good and avoid evil.

You can see his exact verse here. We are called to do good and avoid evil. Again—action. That action must be protected.

The Hippocratic Tradition

What does that look like in terms of the physician?

Well, while he was not a Catholic—I’d like to think he is now—Hippocrates, the father of Western medicine, gave us a very important phrase in his oath that he wrote, well, that we think his students wrote, that bears his name.

And it’s important that we emphasize this:

“I will benefit my patients according to my greatest ability and judgment.”

The exercise of conscience. Turning from evil and doing good. Hippocrates, the Greek school—they knew this. This was written on their hearts as well.

Abortion: The Preeminent Issue of Our Time

Now we can think of a number of issues—and I’ll get to a slide where we’ll at least identify a few of them. But one of the preeminent issues of our time—the preeminent issue, and one of the many issues, I should say, of life—but the preeminent one is abortion: taking the life of the unborn in the womb of his or her mother.

When it comes to informing one’s conscience—if we know by way of natural law, that which is written on our hearts, that we ought not, that we should do good and avoid evil—and St. Thomas tells us that a secondary precept, so as we’re moving more specific, we turn to the Decalogue, we turn to the Ten Commandments, where we’re told:

“Do not kill.”

Notice, there’s no qualifiers. Do not kill just the elderly. Do not kill just the guilty. Do not kill someone else.

One of, I think, the most important arguments against physician-assisted suicide is the fact that do not kill is without qualification. That prohibits harm to oneself. Thou shalt not kill is the secondary precept following that first precept to do good.

Catholic Moral Teaching as Guide

For a Catholic, we are so blessed to have such a robust corpus of moral teaching to rely on. I know I’m called to do good. But in the world I live in today, for a number of factors, I may no longer be able to see that which is good. I may no longer be able to understand that which is good.

The Catholic Church—and Pope Francis gives us this. This actually goes back to John Paul II, but Pope Francis has a general audience in which he discusses briefly but beautifully one of my favorite names for our Church, and that’s Mother.

She gives spiritual life to us through baptism. She feeds us through the Most Blessed Sacrament. She forgives us. She also teaches us.

In the world we live in today, sometimes it can become confusing. And I look at organizations like the National Catholic Bioethics Center as helping to synthesize all of this moral teaching, all of this guidance, so that we may live well and flourish, so that we may turn away from the evil and do the good.

Sources of Catholic Moral Teaching

Everything is rooted in Sacred Scripture.

We have the Didache, which is the writings of the Twelve Apostles, in which we first hear the prohibition on abortion.

We have John Paul II’s Evangelium Vitae, The Gospel of Life.

We have the Catechism of the Catholic Church.

If you do not know the Ethical and Religious Directives for Catholic Healthcare Services, I highly suggest that you open that document. It’s free, it’s accessible online. If you have any problems, please see me.

But you can see how the Holy Mother Church guides our healthcare professionals, so they know what is good, so they avoid what is evil. Many—most—already know this. But sometimes that additional guidance from our Mother helps us along the way to do good and turn away from evil.

And then—even though it’s hard to read—the Congregation for the Doctrine of the Faith, the Dicastery now, often gives us very precise analyses, moral analyses of these issues.

This entire tree of moral teachings is meant to emphasize one thing: it is written in our heart to do good and avoid evil. And the Catholic Church is there to help us best understand that along the way.

When we have a Catholic healthcare professional who says:

• I refuse to kill a child in his or her mother’s womb.

• I refuse to render somebody with a perfectly functioning reproductive system infertile.

• I refuse to prescribe thousands of milligrams of barbiturates so somebody can end their own life in a tragic act of desperation.

When they make those conscience claims, they have standing behind them a robust moral teaching, a robust moral understanding of the life issues.

Other Moral Issues in Healthcare

Of course, there are other issues. We have abortion, yes—preeminent issue of our time, taking the life of the unborn child in his or her womb.

We have artificial and assisted reproductive technologies.

We have gene editing—CRISPR—wrapping our minds around this technology. How can it be used for the good, and when should it be avoided because we recognize its use as evil?

One of the more common questions I get asked when it comes to healthcare is cooperation with evil.

I thought one way to show this, to make it evident, is the picture of the syringe: vaccines.

Praise God we came out of COVID. But there were a lot of moral questions that were raised during that time. One of which is: What do we do with these vaccines that may have been derived in some fashion from cells that came from an abortion?

So—vaccines with abortion-derived cell lines.

We have abortion in the womb, we have body modification and mutilation, we have ordinary and extraordinary means: when is it morally permissible to discontinue mechanical ventilation, when is it morally permissible to refuse cardiopulmonary resuscitation?

These are all questions that the Church helps guide us.

Of course, we have physician-assisted suicide, and we have the new controversy—which, if you’re not following it, I really do highly suggest you do—and that’s on what we call the neurological criterion of death, or brain death.

It’s very important that we are becoming very familiar with the science because of its implications. What are the consequences if we fail in our united defense of religious freedom in healthcare?

The Reach of Catholic Healthcare

I think this chart is incredibly useful to help us understand the reach of Catholic healthcare, at least in the United States—and we can also say, very much, globally.

I’m going to take the microphone out so I can walk over. Okay, so if you can’t see it, I’m going to try to read through some of these statistics with you, and then I would like to put them in context.

• Every day, more than one in seven patients are treated in a Catholic healthcare facility.

• 74% of Catholic hospitals are in urban areas.

• You can see where all of the continuing care facilities are, the reach of Catholic healthcare, the number of employees Catholic healthcare has.

• Nearly 500,000 babies were born in Catholic hospitals last year alone.

I want to give you just a moment to take those statistics in.

And I want you to think about: what are the consequences should we fail in our defense of religious freedom in healthcare?

If you have been to a hospital lately—sadly, I have—you are seeing individuals being treated on gurneys in the hallways of emergency rooms. People needing to wait hours for basic assessments.

What Happens If We Push Out Physicians of Faith?

I want to ask you this—and I don’t think I have to convince you, but maybe you can share this with someone who’s not convinced: what will American healthcare look like if we push our Catholic healthcare professionals out of their profession?

If we give them the dreadful choice—that is so un-American—“It’s either your faith or your employment”? How will that affect healthcare in America?

And I also want to amplify it in this way: we are talking about Catholic healthcare—one in seven—but what about our non-Catholic Christian brothers and sisters who are in healthcare? What about our Jewish and Muslim brothers and sisters who are in healthcare?

Because many of them share the same moral orthodoxies as us. At the Religious Freedom Institute, we are blessed to see united people of all different faiths.

Now—they may disagree on the reality of God. Of course they do. There are very big theological differences. But if the law of God is written on the heart of every man, woman, and child, then they too see that we ought not to kill. That God created us male and female. That the first educators and first protectors of children are indeed the parents.

Not through the fault—I’m not pointing a finger—not through the fault of any one institution, or one area of the profession, but the fact that we have a healthcare profession that is pushed to the brink.

Hours and hours and hours are spent on patients—gladly so, at the privilege of our healthcare professionals—but they themselves are seeing how much is needed in order to help them perfect their profession and serve those whom they are called to serve.

We know, looking at the statistics, that in the next 15 to 25 years we are going to be at a deficit of healthcare professionals—from nurses all the way up to specialty surgeons. The only field that I’ve seen that is being prevented from this kind of dire shortage in employees are physician assistants.

Other than that, I am seeing hundreds of thousands of nurses in terms of a shortage, and tens of thousands of physicians up through the specialties.

Interfaith Agreement Against Euthanasia

And I would draw your attention to a document that came out of the Pontifical Academy for Life only about six years ago. I will not say the entire name, because it took two lines of the document—but it was a document of agreement among Jewish, Islamic, and Christian scholars that said there is no place in medicine for physician-assisted suicide and euthanasia.

It is an evil act that must never be practiced. And for all of the individuals who suffer, palliative care is the remedy. It is that which should be pursued—never abandonment to despair.

Do we have different theological beliefs? Absolutely we do. Do we share the same moral code written on our hearts? We do—and the Pontifical Academy for Life’s document is a prime example.

What happens when we have Muslims, Jews, and Christians—those healthcare professionals who live in states that may not mandate that they write the lethal prescription, but that require they refer?

If you don’t know about this, I really do recommend you look into it. Look at state laws in the United States on physician-assisted suicide. You will see rather explicit protections that no physician should be compelled to be one of the two who has to sign off and write the prescription for a lethal dose.

But—I challenge you to look for any protections against referring. That is a terrible inclusion in those documents.

We are saying to people who recognize the evil of physician-assisted suicide: you yourself will not participate, you will not give the means for someone to take their own life—but you will write permission and direct them to the doctor who will do it in your place.

That is a cooperation with evil that we cannot participate in.

So my question to you is this: using Catholic healthcare as the case, but also recognizing believers of the same moral orthodoxy who recognize the law written on our hearts—what is going to happen to healthcare in our country, and around the globe, when we push those people out? When we push those professionals out?

It is a situation that we must be able to respond to.

Federal Protections & Their Limits

Now—in terms of protections from the federal perspective—we do have regulations in place. But I want to qualify that comment with something.

We can look here, of course, flowing from the recognition—not the allowance, but the recognition—of the free exercise of religion in the first 16 words of the First Amendment.

We have Title VII protections of the Civil Rights Act, for example, that protect against discrimination of both employees and job applicants based on their religion.

And then you can go through:

• the Church Amendments,

• the Public Health Services Act,

• and the Weldon Amendment—

all with various levels of protection targeting various individuals or institutions, recognizing and protecting their right not to participate in an abortion or sterilizing procedure.

Filing Federal Complaints

These statutes—these protections—exist. But they require a federal government to take in the complaints, to investigate, and to follow through with the protections.

Can we always count on that to happen?

I do think it’s important—and I have the blessing of working with such remarkable lawyers. For example, Louis Brown from Christ Medicus. In conversations with him, as well as others, I’ve heard this: even if we think our federal complaint will not be investigated—even if it might fall on deaf ears—file it anyway. Get it on the record.

I wasn’t actually going to include this slide, but I’m including it anyway. If you want to take a picture of that QR code, it’ll take you to a one-page document (front and back) on how to file a federal complaint.

It’s a very important document, which I’m so pleased to tell you that the Religious Freedom Institute was part of creating—along with our very good friends at Alliance Defending Freedom, the Ethics and Public Policy Center, and Christ Medicus.

Even if you know people whose complaints aren’t being heard and investigated—file it anyway. Get it on the record.

If the federal government will not offer us these protections—or at least honor these protections—what about at the state level?

Well, here’s where we’re going to start moving a little bit towards action. The Medical Ethics and Diversity Act—what we call the MED Act—is one way in which states can codify into state law conscience protections for their healthcare professionals.

It’s one tool in the toolbox, and I think it’s a pretty important tool.

Origins of the MED Act

The Religious Freedom Institute really led, and from the beginning of this project was really led by our president David Trimble, along with Louis Brown and the Christ Medicus Foundation and the wonderful team at Alliance Defending Freedom.

They have created a bill that can go into any state and can protect, should it be passed to the best we can, the conscience rights of healthcare professionals.

Now I do want to offer just one note here: when I say that we’ve helped with this bill—the Religious Freedom Institute—we are a driving force. Our mechanism of action is educational advocacy.

We don’t go into state legislative bodies and lobby. But what we do is look at states that are in need of these types of protections, and we go and raise awareness. We talk about where the protections are lacking, and also the importance—as I just did, and forgive me, it was very quick—but we talk in depth about the importance of protecting healthcare professionals in their state.

And you know, the title of my presentation includes the common good. It’s not just the healthcare professionals that we are protecting when it comes to conscience rights. We’re protecting the patients who want to go to healthcare professionals who agree with them on these moral issues.

You know, My Catholic Doctor is one of those organizations that has been started because there was a desperate need to find like-minded physicians that are accessible and that strongly hold and practice the teachings of the Catholic faith.

Going back to Hippocrates, I see in them my greatest ability and judgment—a judgment founded on the Church’s teachings. They’re not the only ones, but that is, I think, a very remarkable case to bring up.

Current Status of the MED Act

We need to go through and we need to make this whole map blue. But for right now, I’m very excited to tell you this: Florida, South Carolina, Ohio, Arkansas, and Montana have passed this MED Act. Those are the dark blue states you see.

The greenish-colored states—those are the ones that, as of now, we are targeting for the next legislative session.

So David and I and RFI and Christ Medicus and Alliance Defending Freedom—we are going state by state using the resources we have. Unfortunately, we can’t get them all right away, but using the resources we have to go, on RFI’s behalf, to educate, and then for Christ Medicus and ADF to provide, to explain, and to hopefully have passed this Medical Ethics and Diversity Act.

Protections Provided by the MED Act

One tool in the toolbox—now, this provides the MED Act.

The MED Act provides conscience protections: that people cannot be fired for following their conscience, that there cannot be any sort of retaliatory effects—refusing promotion or demoting them, loss in publications, or what have you.

Also, clear whistleblower protections.

But one of the things the MED Act does as well, which I think is very important: it has a private cause of action—sometimes they say private right—included in it. And that means that along with filing your federal complaint, which you should, it allows individual physicians and healthcare professionals to take their case to the courts.

It allows them to seek remedy rather than having to go through sometimes a very large mechanism—a very prolonged mechanism, a very inefficient mechanism. It allows them to take the fight to the courts themselves.

This is actually a quote from Arkansas’s MED Act that was passed in 2021:

“A civil action for damages or injunctive relief, or both, may be brought by a medical practitioner, healthcare institution, or healthcare payer for a violation of the subchapter.”

It is another tool for healthcare professionals to, yes, file the complaint, but also take it to their states, to take it to the individuals who are violating their conscience—should they be fired, should they be docked in pay, should their hours be lowered, whatever it may be when it comes to the violation of conscience.

I think this MED Act has tremendous potential, and I hope to see great effects—great fruit—out of the five states that have passed it.

Action Items for Religious Freedom

So we conclude with this: what are some action items? What are some things we can do?

I have heard it over and over at presentations this week—rightly so. Rightly so.

1. Pray. The first thing we must do is to pray—pray fervently for the protection of America’s healthcare professionals. I keep saying this because I truly believe it. We are called to serve those who serve us. It is a very unique relationship between patient and the doctor. We are called to serve them as much as they are called to serve us—but just in a different way. Pray for them.

   I also heard—even though I didn’t include this—I also heard this week, and it’s a great reminder: the importance of fasting. The importance of fasting. Pray and fast.

2. Research your state’s conscience protections. After I emphasized the Medical Ethics and Diversity Act—the MED Act—find out about your state’s conscience protections. A little homework: wherever you go home tomorrow or on Monday, start looking into how does my state protect the conscience rights of healthcare professionals?

3. Connect with RFI. That leads us to number three: connect with RFI. I have a QR code there—if you scan that, it’ll take you right to our Medical Conscience Rights Initiative tab on our website, our specific page. Connect with us. Let us know how we can help.

   Perhaps it’s the MED Act, perhaps it’s getting more information about that, perhaps it’s how to write your legislator, perhaps it’s just how to better explain the importance of conscience. Just like each one of us individually are here to serve, RFI is here to serve too. And so I ask you to really take a very urgent effort to follow through with some of those, if not all of those, action items.

Let’s end with a prayer.

We have a lot to pray for. I know we all very much believe in God’s providence, and on my flight out here on Wednesday, I was praying my Liturgy of the Hours. And this was the responsory psalm, and I was just so moved by it. I said, “Yeah, I was looking for how to close this presentation that emphasized the law, and the Lord gave it to me—37,000 feet, I don’t know, above Kansas, Ohio, somewhere along the way. I try not to look out the window.”

So let’s pray this together:

In the name of the Father, and of the Son, and of the Holy Spirit. Amen.

I’ll read the bold, if you can read the response.

In the depths of his heart, the law of God is his guide.
— Alleluia, alleluia.

He will never lose his way.
— Alleluia, alleluia.

Glory to the Father, and to the Son, and to the Holy Spirit.

Dear Lord, we close our time together just in gratitude for each other’s company, in gratitude for this conversation, in gratitude for our healthcare professionals and our medical students, in gratitude for everything You have given through Your Church to the world—that Catholic healthcare provides and leads the way.

You inspired the words: “I have set before you this day life and good, death and evil. Choose life.”

Lord, we close out our presentation today resolved not only to choose life ourselves, but to ardently defend that choice for our healthcare professionals—both in the United States and abroad.

Amen.

In the name of the Father, and of the Son, and of the Holy Spirit. Amen.

Thank you very much for your time today.