From this perspective, put bluntly by the British Equality and Human Rights Commission Chief, Trevor Phillips, religious beliefs end “at the door of the temple.” For Catholic Christianity, the duty to evangelize non-Christians and to serve the poor, sick, homeless, prisoners, widows, and orphans—both Christian and non-Christian—is not an optional add-on to the free exercise of religious faith. These duties have been a corporate responsibility of the Church, not just of individual members, from the very beginnings.
Conscience, Professional Duty, and Moral Agency
Conscience and Duty
The argument against conscience exemptions for health-care and social-service professionals (physicians, nurses, social workers) is typically framed as a conflict between an individual’s or institution’s right to decide what services or treatment it will provide and patients’ rights to treatment.
The client’s right to a full range of services may depend on professionals’ willingness to provide them, especially in rural areas. As the chair of the ethics committee of the American College of Obstetrics and Gynecology put it, the “reproductive health needs” of women should trump the moral qualms of doctors.41
In this discourse, the personal is contrasted with the professional, the idea being that a professional has a duty to provide whatever services are legal and demanded by clients. The conscience of the professional is invariably given short shrift and subordinated to the supposed right of the client to treatment.42 In a shift characteristic of contemporary rights discourse, a right to freedom from state interference (a “right to privacy”) is transformed into a claim on public provision.43
One response to the conflict between conscience and the newly defined duties supported by the new moral orthodoxy is to say, “Fine, if you cannot in conscience meet the expectations and duties of the profession, leave it or choose a different line of work.” This may indeed be the only option facing conscientious individuals where no accommodation is made.
The exclusion from their professions of physicians, nurses, social workers, and pharmacists who adhere to the traditional Judeo-Christian religious orthodoxy and the closing down of institutions that respect life and adhere to Hippocratic ethics have practical consequences. But my argument here against exclusion does not depend on the empirical reality that religious professionals and institutions—for example, Catholic and other Christian physicians, nurses, social workers, and pharmacists, as well as hospitals and clinics—play an important role in the American health-care system. Their exclusion would involve a tremendous loss of talent, knowledge, skill, aptitude, and dedication for the healing professions. It would also substantially reduce health care, child welfare, and social services of all kinds and therefore the access of patients and clients to such services. The point, rather, is that the coercion of conscience of professional health-care and social-work providers is morally corrupting for the professions and their practitioners and damaging to civil society.
There is a sharp difference between allowing and requiring professional participation in certain services or treatments. Requiring participation pressures some professionals into morally degrading choices to act on beliefs contrary to those they hold, as a condition of entering or remaining in their chosen profession. To require violation of conscience in this way corrupts the profession and those who submit to such requirements. A regrettable irony is that the moral integrity of persons, and so of associations and their members, is itself constitutive of “human and community well-being,”44 which social work and the other helping professions claim is their purpose to promote.
The Moral Agency of the Practitioner
The idea that if an action is legally permissible and demanded by a client, the social worker (or other health professional) has the duty to provide or participate in providing the requested service itself represents a fundamental shift in the balance of rights and powers between professional and client. It strips the professional of her full moral responsibility and reduces her to a kind of machine to deliver what the customer demands. The professional’s right and duty to use her judgment about what is required or indicated or morally permissible is nullified. A new form of client “empowerment” thus radically disempowers, even dehumanizes, the professional.
Opponents of conscience clauses and exemptions sometimes frame the matter in terms of religious professionals’ desire to impose their personal views or morality on clients or patients. This is a misunderstanding. The case for conscience exemptions has nothing to do with imposing my will on the client.
The client may find abortion morally permissible, and it is certainly legally permissible at present in the United States. I respect the client’s right under law to decide to have an abortion and will not condemn, moralize, or argue with her. But this is not the issue at stake with respect to conscience exemptions.
My right not to participate in what I believe is grave wrongdoing does not imply or depend on a right to impose my belief on the client. “Conscientious objection,” Edmund Pellegrino writes, “implies the physician’s right not to participate in what she thinks morally wrong, even if the patient demands it. It does not presume the right to impose her will or conception of the good on the patient.”45
The question of whether someone’s right to engage in a behavior entails an obligation on anyone else’s part to assist her in the process has important implications for all professionals, but especially those supposed to be helping or healing their clients. In many cases, such legally mandated obligations pose serious threats to conscience and, as such, to professionals’ humanity as moral agents. The issue, which applies to lawyers and physicians no less than to social workers, is only in part whether a professional is obliged to serve anyone who seeks her services. Leora Harpaz, discussing the 1997 ruling of the Massachusetts Commission Against Discrimination that a woman lawyer could not refuse to represent men in divorce actions under the state’s public accommodation statute, shows that the issue of compelled service is not simple or confined to the health and helping professions.46
For social workers and many other professionals, as for priests, it is common to serve clients whose behavior they find morally repugnant. The challenge to conscience arises not from the requirement to serve—or not to discriminate against—a particular kind of client, but from the expectation in certain cases that practitioners will act against their own judgment and collude or participate in what the practitioner determines is wrong or harmful, simply because the client demands it.
Whose conscience counts, the client’s or the professional’s? This is the wrong question. No one can be bound by someone else’s conscience. The professional remains a moral agent, not a robot or vending machine, and so is responsible for following his or her own practical judgment about the right thing to do, all things (including the client’s wishes) considered.
Licensing and Professionalism
A novel view of professional licensing also emerges to support opposition to conscience exemptions, one that further narrows the scope of civil society, the social space between individual and state. In this view, licensing, traditionally justified as protecting the public by ensuring the competence of practitioners, becomes a process whereby professionals are transformed into public officials. And when they become public officials, they become legally bound to act in certain ways, regardless of personal conscience. If the state decides to recognize same-sex marriage, for example, then its public officials who issue marriage licenses are legally bound to issue those licenses to whomever the state decides is now qualified under its rules. Period.
So licensing of professionals, insofar as it transforms the practitioner into a public official obliged to do the state’s bidding, has the effect not of safeguarding professional discretion while protecting the public, but of deprofessionalization. Social workers, precisely because they are among the least secure in their professional status, are less inclined to defend the scope and legitimacy of their own professional judgment and discretion against
tendencies to subordinate them to bureaucratic-state or client demands.
Analogously, by providing most of the funding of voluntary social-service agencies like Catholic Charities, the state turns these into its own agents. Far from being a strength of civil society which guards the space between state and individual, such agencies become vehicles for increasing the reach of the state. Rather than allowing for alternative visions of the common good in the associations that people with differing religious and moral commitments have built over generations, the state weakens civil society and becomes absolute sovereign of all.
Conscience, Subsidiarity, and the State
The coercion of Christian consciences is a threat not only to individual practitioners but also to the institutional pluralism that lies at the heart of subsidiarity, social justice, and American democracy. From this perspective, it is wrong to reduce matters of conscience to the state’s protection of individual rights, whether of consumer against provider, or professional against employer. Conscience is not simply a matter of individual rights or individual autonomy vis-à-vis the state and civil society. It is inherently relational.
This case for the relational dimension of conscience, in contrast to an emphasis on individualist rights talk and on the autonomous self, is persuasively made by Robert Vischer, who seeks to recapture the concept of conscience as shared knowledge. He argues,
There is a clear need to recapture the relational dimension of conscience—the notion that the dictates of conscience are defined, articulated, and lived out in relationship with others. Our consciences are shaped externally, our moral convictions have sources, and our sense of self comes into relief through interaction with others. By conveying my perception of reality’s normative implications, my conscience makes truth claims that possess authority over conduct—both my own and the conduct of those who share, or come to share, my perception.47
This argument has at least two important implications. First, conscience is not simply an internal oracle like a preference in ice cream flavors. It implies shared knowledge and truth claims about right action. And it binds those who share that knowledge and accept those truth claims.
Second, shaping our consciences is a matter of neither the individual nor the state, but of the subsidiary associational life that mediates between them, especially church and family. These are sources of conscience formation, communities of discernment, and venues for expression. In Vischer’s words: “When the state closes down avenues by which persons live out their core beliefs—and admittedly, some avenues must be closed if peaceful coexistence is to be possible—there is a cost to the continued vitality of conscience.”48
Catholic social teaching offers a sharp contrast to the Hobbesian picture, in which “the sovereignty of Leviathan is absolute, so subsidiary units of the social order—churches, groups, smaller units of government—exist merely at the sufferance of the sovereign.”49
Attacks on religious freedom and conscience relentlessly seek to impose a new orthodoxy and an attendant intolerance of dissent from subsidiary associations—even, in Canada, imposing the new sexual morality on the curricula of private religious schools and homeschooling families.
The issue of conscience, then, needs to be understood not only in terms of the rights of individuals, who must look to the state for relief or protection, but also and especially in terms of the scope for a rich associational life that subsists in tension with both individual and state. A commitment to freedom of conscience, properly understood, “should underlie our legal system’s reluctance to restrict the independence of the myriad associations that make up the vast space between person and state.”50
Driving Christian organizations and professionals out of health-care, education, and social services does great social harm on several levels. Most directly, it threatens a tremendous loss of talent, knowledge, skill, aptitude, and dedication for these professions. It would also substantially reduce health care and social services of all kinds, and therefore the access of patients and clients to such services. In addition, coercing the consciences of professionals is morally corrupting for both individuals and their professions. Christians are bound to follow their correctly formed conscience, even if it means loss of livelihood. Some will fail the test, however, in the name of what is now called leaving your personal values at the door. But a regime that requires such heroic sacrifice of its members—like that of Antiochus IV Epiphanes—is also corrupt, falling into what has been called a soft or liberal totalitarianism.
Individual or group conscience is not at odds with the common good but constitutive of it. The common good is not solely expressed or subsumed in the state, but requires a healthy institutional pluralism.
Some Conclusions
One kind of choice in social-welfare policy is often reduced to a dichotomy between individualism and collectivism. This reduction not only artificially narrows the range of possible policy options51 but also misses the ways in which these ideologies in practice reinforce and depend on each other precisely by hollowing out the space between individual and state.
Pius XI made the same point in a surprising context, the publication of his social encyclical Quadragesimo Anno (1931), at a time when Communist, Fascist, and National Socialist totalitarianism were ascendant. Startlingly, Pius blames individualism for pushing the state in this direction:
When we speak of the reform of institutions, the State comes chiefly to mind, not as if universal well-being were to be expected from its activity, but because things have come to such a pass through the evil of what we have termed “individualism” that, following upon the overthrow and near extinction of that rich social life which was once highly developed through associations of various kinds, there remain virtually only individuals and the State. This is to the great harm of the State itself; for, with a structure of social governance lost, and with the taking over of all the burdens which the wrecked associations once bore, the State has been overwhelmed and crushed by almost infinite tasks and duties.52
Both Catholic social teaching and the social-work empowerment tradition reject the individualist hypertrophy of the autonomous unencumbered self no less than the hypertrophy of the state. The space—of civil society or mediating structures—between individual and state is the one in which conscience is shaped and the virtues on which it depends are developed through practice and habituation. The virtue of social justice also requires and develops that space in which citizens join together in pursuit of the common good.
[CHAPTER 17]
Marriage as a Social Justice Issue
MARRIAGE IS A SOCIAL JUSTICE ISSUE. INDEED, IT IS CENTRAL to the possibility of a just society. Historically and universally our most child-centered institution, marriage and the marriage-based family, reduce the risk of poverty, crime, mental and physical illness, poor educational outcomes, domestic or intimate-partner violence, and so on. The marriage gap between the more educated and affluent on one hand, and the poor and middle class, both black and white, on the other, is widening. That is both a reflection and a source of increasing inequality.1 Paul R. Amato’s 2005 study shows the profound impact on children of changes in family structure since 1970, when the sexual revolution took off.2 The consequences associated with these changes include the explosion of divorce, an increase in nonmarital births, and rises in cohabitation and fatherless and blended families. The revolution’s defining feature was the destigmatization and increased incidence of almost all kinds of sex inside and especially outside of marriage. If U.S. family structures were as strong today as they were in 1970, he calculates:
643,000 fewer children each year would fail a grade at school
1,040,000 fewer children each year would be suspended from school
531,000 fewer children each year would need psychotherapy
453,000 fewer children each year would be involved in violence
515,000 fewer children each year would be cigarette smokers
179,000 fewer children would consider
suicide
71,000 fewer children each year would attempt suicide.
Children’s experience of repeated family-structure change has a robust association with compromised development across the early life course. In a recent study published in the Journal of Marriage and Family, Paula Fomby and Stacey Bosick investigate the relation between family-structure instability during childhood and adolescence and children’s transition to adulthood, up to age 24.3 Using data from the National Longitudinal Study of Adolescent Health (N = 8,841), the researchers find evidence of associations between early and later family instability and low rates of college completion, early union formation and childbearing, and early entry into the labor force. The researchers find that these associations are explained by family structure, delinquency, and academic performance in adolescence.
Another study conducted by Michael Gähler and Anna Garriga, using longitudinal data from two waves (1968 and 2000) of the Swedish Level of Living Survey, finds that as alternative family forms have become more prevalent and accepted, the negative impact of parental divorce on children has not faded.4 The evidence from Sweden suggests that the link between parental divorce in childhood and psychological distress in young adulthood remains as robust now as it was forty years ago. This link is strong, in spite of government policy to offset the negative effects of parental divorce on children and the social acceptance of divorce.
The considerable benefits of marriage, attested to now by decades of social-science research and recognized by scientists across the political spectrum, cannot be reduced to a selection effect. That is, it is not simply that healthier or more affluent people are more likely to get married in the first place, regardless of any independent effect of marriage itself. Of course marriage does involve this kind of selection. That’s part of its purpose and function—as personified in the young woman’s father who questions the young man about his prospects. But we know from longitudinal studies that follow subjects as they enter, leave, and reenter marriages, that marriage has benefits from the start that other kinds of relationship status lack. These benefits that distinguish marriage from other kinds of relationships begin even before the wedding, with the increase in earnings and decline in risk-taking behavior of young men when they get engaged.5 The benefits for women and men and their children—in income, health, mental health, and so on—are lost with divorce and regained with remarriage (the more so the shorter the gap between marriages).6
Social Justice Isn't What You Think It Is Page 27