On July 1, the ACLU Legislative Office accused Catholic hospitals of potentially violating the Emergency Medical Treatment and Active Labor Act by refusing to provide “abortion services.” In a letter to the Centers for Medicare and Medicaid Services, ACLU counselors argued:

Religiously affiliated hospitals across the country inappropriately and unlawfully deny pregnant women emergency medical care.

That’s a heavy charge, and the ACLU’s intent could not be clearer: (1) force Catholic hospitals to comply with their interpretation of federal law, which includes abortion under “emergency medical care”; or (2) penalize Catholic hospitals by accusing them of violating the ACLU’s interpretation of federal law.

These folks will not be stopped in their thinking and feeling. Here, St. Paul couldn’t be clearer:

For although they knew God, they did not honor him as God or give thanks to him, but they became futile in their thinking, and their foolish hearts were darkened (Romans 1:21; ESV).

Stop idolatry, because “a mind is a terrible thing to waste.”

HT: Left-leaning RHRealityCheck.org.

Robert C. Baker

For partial credit toward MHE 604 Section 01 Social and Cultural Contexts
of Health Care – Summer I 2010

Word Count: 1,935

Abstract: The Commission on Theology and Church Relations (CTCR) of The Lutheran Church–Missouri Synod (LCMS) aids that church body in providing “leadership in dealing with the Synod’s needs and opportunities in the areas of theology and church relations.” For nearly fifty years, the CTCR has issued a number of reports touching upon biomedical and health care ethics issues, including those pertaining to the beginning of human life. Because the CTCR’s reports influence the decisions reached by both LCMS clergy and laity, thus touching upon issues of personal autonomy, this paper examines three of those reports to discern if and how that principle is understood and applied by the CTCR. The paper concludes with a general observation how the reports may be interpreted.

Introduction

The Lutheran Church–Missouri Synod
The Lutheran Church–Missouri Synod (LCMS) is the second-largest Lutheran Church body in the United States. Founded in 1847 by German immigrants seeking religious freedom so that they could practice a traditional form of Lutheranism, by 2008 the Synod had grown to over 2.3 million baptized members residing in every state of the Union.1,2 By and large, the Synod is known outside of its own circles as a conservative, Protestant church body having affinities with conservative Protestantism (a high regard for the Scriptures and traditional moral values), Evangelicalism (a special emphasis the Gospel, or Good News of salvation in Jesus Christ), and Roman Catholicism (traditional liturgy with vestments, candles, crucifixes, and chanting, an ordained all-male clergy, and a deep piety toward the Sacraments, including auricular confession). The LCMS maintains the largest Protestant parochial school system in the United States, which is second only to that of the Roman Catholic Church.3

The Commission on Theology and Church Relations
Since 1962, the LCMS’s Commission on Theology and Church Relations (CTCR) has worked to provide “leadership in dealing with the Synod’s needs and opportunities in the areas of theology and church relations.”4(p.1) Comprised of the Synod’s president and vice president, presidents of the church body’s two seminaries, pastors, teachers, and laypersons, committee members are “carefully chosen so that [the CTCR] is as representative of the Synod as possible.”4(p.1) In addition to providing theological guidance to synodical leaders and organizations, the CTCR also publishes and disseminates theological reports at the request of the Synod. These enable official synodical leaders, organizations, parishes, and ordained clergy and commissioned ministers to carry out their duties in line with the Synod’s teachings. The CTCR also advises and recommends the official recognition of other Lutheran church bodies for “altar and pulpit fellowship,” or full eucharistic communion. The LCMS and its members attach great importance to the work of the CTCR, particularly in the areas of biomedical technology and health care ethics.

A Descriptive Focus
Normative ethics, which appeals to moral rules or principles, can be distinguished from descriptive ethics, which examines moral behavior as it plays out in the world. This distinction is important in that ethics understood by description, rather than mandated by theory or principle, can help justify ethical action.5(p.5) Because religious beliefs directly influence moral decision-making regarding health care and health care choices,6(pp. 164-166) it is important to examine reports by church bodies and their various entities that press upon personal autonomy. To that end, this paper will do the following. Following a brief recital of the principle of respect for autonomy as interpreted by Beauchamp and Childress, three CTCR documents related to the beginning of human life will be examined: Christian Faith and Human Beginnings: Christian Care and Pre-implantation Human Life (2005); What Child Is This? Marriage, Family, and Human Cloning (2002); and Christians and Procreative Choices: How Do God’s Chosen Choose? (1996). Next, a determination will  be made whether these documents uphold the principle of autonomy and, if so on what grounds. Finally, since official religious pronouncements have “significant power to shape and transform the meanings attached” to health care and related issues,7(p.259) this paper will conclude with a general observation about a possible affect these CTCR reports have on personal autonomy and decision-making for both clergy and lay members of the LCMS.

The Principle of Autonomy
Beauchamp and Childress (2009) recognize that while the concept of the rights of persons to make autonomous choices is generally recognized, of what autonomous choice actually consists can receives various treatments.8(p.99) While the principle of respect for personal autonomy is derived from Greek political theory,8(p.99) the personalization of autonomy later received extensive expansion during the Enlightenment. Contributing to that expansion was the philosophical work of Immanuel Kant and John Stuart Mill, which focused on the autonomous, rational moral self. The emphasis on personal autonomy and decision-making have especially influenced and penetrated Western thought,8(p.103) including biomedical and health care ethics. As an example, Beauchamp and Childress place the respect for autonomy as one of four key ethical principles in health care, the others being beneficence, non-maleficence, and justice. Here it is important to note that the principle of respect for persons, supporting the broader concept of personal autonomy, also has been enshrined in federal law through the Belmont Report (1979). The Report recognizes that respect for persons includes an obligation to both (1) treat individuals as autonomous agents; and (2) protect persons with diminished autonomy.9

Three Reports Pertaining to Beginning-of-Life Issues
The first CTCR report to be examined in this paper is titled Christian Faith and Human Beginnings: Christian Care and Pre-implantation Human Life, which was published in September 2005. In its fifty-one-pages devoted to discussing embryonic stem cell research, the report seeks to make “progress toward consensus across the broad range of opinions found in our society and in the LCMS,” with the assumption that not all persons will approach issues related to pre-implantation human life with the same biblical hermeneutic as the Synod.10(p.8) To that end, the report hopes: (1) to offer a “careful articulation of competing viewpoints” about these issues; as well as (2) to aid the synodical members in articulating the Synod’s pro-life position.10(p.9)Along with noting the “competing viewpoints” concerning embryonic stem cell research, the report likewise provides basic scientific information regarding human development while applying pertinent Bible passages speaking to the same. Ultimately, the report concludes that those who would seek to justify using fertilized human oocytes (blastocysts, or embryos) for scientific research have a burden of proof to demonstrate that such research, which inevitably results in the destruction of human life, is morally permissible.10(p.43)

A second and earlier report titled What Child Is This? Marriage, Family, and Human Cloning, was published in April 2002. At twenty-three pages, the report aims “to make a contribution to the ability of Christians to discern when to celebrate emerging gifts and when to witness against looming evils.”11(p.6) The report seeks to apply Scripture passages concerning “marriage, family and procreation. . . in light of God’s redemptive purposes” to the issues of human reproductive cloning.11(p.6) Ultimately, the CTCR suggests that reproductive cloning is unacceptable because (1) it is the procreation of human life outside the context of marriage; (2) since it upsets the balance of contribution of genetic material it likewise violates a purpose of marriage; (3) the cloned individual would be deprived of “normal conditions for establishing its own identity” (presumably by having two, opposite-sex parents).11(p.19) As an alternative, the report suggests that infertile couples be encouraged to consider the adoption of children. The report concludes with an exhortation to caution about the “grave moral dangers in the practice of cloning,” and an emphasis on “assessing contemporary technologies. . . in light of Christ’s promise of new birth” through Holy Baptism.11(p. 21)

A third and still earlier report dated September 1996 is titled Christians and Procreative Choices: How Do God’s Chosen Choose? Capitalizing on the popular secular language of “choice,” this forty-page document is devoted chiefly to helping Christians “practice and reflect on what is involved in biblically disciplined moral reasoning.”12( p.5) The report recognizes that Christians often disagree on difficult moral issues attendant to human reproductive technologies and, as such, the report does not intend “simply to [arrive] at one set of answers. . . [but to] explore how thoughtful Christians can become more practiced and adept at biblically disciplined moral reasoning. . . [so that they can] be able to understand the significance of disagreements. . . and how [they] can continue to reason together concerning God’s guidance.”12(pp.5-6) The report uses concepts such as “disciplined chaos” and “biblically disciplined reasoning” to interpret hypothetical case studies involving gestational surrogacy, artificial insemination by donor, a decision by a couple not to have children, and a case involving in vitro fertilization with a marriage.12(pp.7-39) Taking a utilitarian approach, the document makes a cost/benefit analysis of these issues, but all within the context of the marital union. Thus, for example, the CTCR is “troubled” by the potential of IVF abuse, but is likewise “reluctant” to suggest forbidding the procedure altogether.12(p.37)

Absent Autonomy
Although the Christians and Procreative Choices report mentions the word “autonomy” once,12(p.30) it does not refer to autonomy as understood and promulgated by Beauchamp and Childress or The Belmont Report. Neither do the two other CTCR reports. This is especially curious given that reports seek to develop “consensus” toward embryonic stem cell research (Christian Faith and Human Beginnings), provide a “contribution” toward Christian discernment regarding human cloning (What Child is This?), and offer an aid in developing “biblically disciplined moral discipline” regarding procreative issues (Christians and Procreative Choices). That is not to say that the lack of reference to a secular philosophical principle is not unanticipated given the conservative, Bible-based focus of the church body. One could expect that the CTCR, having been delegated with the responsibility by the Synod in formulating theological documents, would follow suit in speaking only when Scripture speaks. Further, such a focus could be justified on the basis of the scriptural emphasis of the Protestant Reformation: sola scriptura, or “Scripture alone.”

However, in that these reports seek to avoid proscribing certain procreative behaviors (for example, by tacitly permitting in vitro fertilization within the context of marriage but discouraging the practice outside of the marital union), doubt is cast as to whether the guidance these reports offers is actually based on Scripture alone, or whether such guidance is based partly on Scripture and partly on some other source of authority. In this instance, for the conservative Missouri Synod it would seem feasible that the Bible’s clear indication of the inherent value of human life (Genesis 1:26-27), as well as the Bible’s prohibition against murder (Exodus 20:13), would carry weight when applied to a procedure in which unused frozen human embryos, even those created by a married couple, could be destroyed due to surplus or for research.

Conclusion
A medical-anthropological approach to biomedicine and health care ethics recognizes the deep influence of “social, cultural, biological, and liguistic” issues that “influence health and well being (broadly defined).”13 Such deep influence includes official reports and opinions of religious institutions. This paper has offered a small window into the contextual religious issues attending moral discernment regarding beginning-of-life issues within the LCMS. While a longer treatment could provide more detail, the examination provided here of three reports from the LCMS’s CTCR has revealed that the principle of autonomy is absent. However, this paper has also noted the CTCR’s emphasis on marshaling Scripture to aid in consensus-building and decision-making. For clergy and lay members of the LCMS, this emphasis and the apparent ambiguity regarding the tenuous and complicated features of beginning-of-life moral decision-making may be the cause for disappointment or frustration, particularly when clear, moral guidance is preferred. Viewed in this light, it could be interpreted that the CTCR reports examined here ultimately rely on and by default commend the Enlightenment principle of personal moral autonomy when it comes to contemporary biomedical and health care ethics issues that the CTCR has determined are not explicitly addressed by Scripture.

References:

1. The Lutheran Church–Missouri Synod. LCMS at a glance. Available at: http://www.lcms.org/pages/internal.asp?NavID=2436. Accessed June 23, 2010.

2. Loest M. The Lutheran Church–Missouri Synod at one hundred and fifty years, 1847 to 1997. Concordia Historical Institute. Available at: http://chi.lcms.org/lcms/synod150.htm. Accessed June 23, 2010.

3. Nafzger SH. An introduction to The Lutheran Church–Missouri Synod. Concordia Tracts. St. Louis, Missouri: Concordia Publishing House, 2009:1-17. Available at: http://en.wikipedia.org/wiki/Lutheran_Church_Missouri_Synod. Accessed June 23, 2010.

4. Lehenbauer JD. What is the CTCR? February, 2010. Available at: http://www.lcms.org/pages/internal.asp?NavID=10558. Accessed June 23, 2010.

5. Hoffmaster B. Introduction. Bioethics in social context. Hoffmaster B, ed. Philadelphia, Pennsylvania: Temple University Press, 2001:1-11.

6. Beeson D and Doksum T. Family values and resistance to genetic testing. In: Bioethics in social context. Hoffmaster B, ed. Philadelphia, Pennsylvania: Temple University Press, 2001:153-179.

7. Marshall P and Koenig B. Accounting for Culture in Globalized Bioethics. J Law Med Ethics. 2004;32(2):252-266.

8. Beauchamp TL and Childress JF. Moral principles: Respect for Autonomy. Principles of biomedical ethics. 6th ed. New York, New York: Oxford University Press, 2009:99-148.

9. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report. U.S. Department of Health, Education, and Welfare. April 18, 1979. Available at: http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.htm. Accessed June 24, 2010.

10. Commission on Theology and Church Relations. Christian faith and human beginnings: Christian care and pre-implantation human life. September 2005. Available at: http://www.lcms.org/pages/internal.asp?NavID=504. Accessed June 23, 2010.

11. Commission on Theology and Church Relations. What child is this? Marriage, family, and human cloning. April 2002. Available at: http://www.lcms.org/pages/internal.asp?NavID=514. Accessed June 23, 2010.

12. Commission on Theology and Church Relations. Christians and procreative choices: How do God’s chosen choose? September 1996. Available at: http://www.lcms.org/pages/internal.asp?NavID=514. Accessed June 23, 2010.

13. “What Is Medical Anthropology?” Society for Medical Anthropology Web site. Available at: http://www.medanthro.net/definition.html. Accessed June 24, 2010.

The White House’s proposed executive order to “deal” with the abortion problems in the Senate health care reform bill reveals that the President will not even attempt to ensure that there is no federal funding for abortion or mandates for abortion coverage in the bill.

The first section of the proposed executive order provides that that “it is necessary to establish an adequate enforcement mechanism” to prevent federal funding for abortions “consistent with . . . the Hyde amendment.”  While this acknowledges that the Senate bill is not consistent with the Hyde amendment, the language of the executive order fails to describe accurately and to mirror the scope of the Hyde Amendment.

While the Hyde Amendment comprehensively prohibits the use of all federal funding that flows through Labor, Health and Human Services (LHHS) appropriations for both abortion and insurance plans that cover abortions, the Senate health care bill does not.  The executive order does not remedy this problem.  First, the executive order only addresses the insurance exchanges (section 2) and the Community Health Center (CHC) funding (section 3).  In other words, the executive order still leaves open the possibility that other funds authorized or appropriated through the bill could be used to directly pay for abortions.

Second, while the executive order addresses the insurance exchanges, it utterly fails to apply Hyde to them.  Section 2 of the order provides guidelines for “strict compliance” with the provisions in the bill that address how federal subsidies are handled in plans that cover abortions in the exchanges.  However, these guidelines do nothing to prevent federal subsidies from going to plans that cover abortions, which directly violates federal principles embodied in the Hyde Amendment and other federal laws, including the Federal Employee Health Benefits Program (FEHBP).

Current law forbids federal dollars from going to insurance plans that cover abortions, regardless of whether or not the dollars directly pay for abortions.  In contrast, all this section of the executive order accomplishes is strict compliance with the anti-life “abortion surcharge” provision in the bill, which segregates the portion of premiums that pays for abortions in plans that cover abortion from federal funds.

Section 3 addresses new funding for CHCs.  As a recap, the Senate bill does not prohibit these new funds from being used to pay for abortions.  While the executive order states that the Hyde Amendment and longstanding regulations currently prohibit the use of CHC funds for abortions, the Hyde Amendment is not applied to CHC funding by statutory law, but only by regulations from an administrative agency.

This section of the executive order states that the Hyde Amendment will apply to the new authorization and appropriation of CHC funds.  While this section may effectively prohibit the use of CHC funds for abortions, a court could interpret the statutory language as requiring the use of the funds for abortions because there is no statutory prohibition, which courts have done in the past with other health care statutory language.

Also, the executive order is not permanent law, just as regulations are not permanent law.  Either or both of these can be repealed by President Obama and his administration fairly easily.

Should this executive order remain in place, it does not even attempt to address the broad mandate authorities in the bill that could be used to require private insurance plans to cover abortions.  For instance, the Mikulski amendment to the Senate bill allows an administrative agency to determine what is “preventive care.”  If abortion is categorized as “preventive care,” private insurance plans will be required to cover abortions.

“It is naive for any elected official, especially one who describes himself as ‘pro-life,’ to expect that a promise to issue an Executive Order that reasserts the intentions of the Hyde Amendment will be fulfilled by the most pro-abortion president to ever sit in the White House. Perhaps Mr. Stupak and his fellow pro-life Democrats forget that President Obama’s first Executive Order was the repeal of the Mexico City Policy to allow for international funding of abortion.

Not only would an Executive Order be rendered meaningless in the face of Congress passing legislation which actively provides for the massive expansion and funding of abortion services, but anyone who doubts the abortion tsunami which awaits this bill becoming law lives in a fantasy world.

Barack Obama has lined every existing federal agency with the most dedicated pro-abortion ideologues, and we know that he will continue this pattern of pro-abortion appointments when it comes time for him to fill the over-100 bureaucracies created to administer his socialized health care program.

Any formerly pro-life Democrat who casts a ‘Yes’ vote for this Senate health care bill tonight will be forever remembered as being among the deciding votes which facilitated the largest expansion of abortion services since Roe v. Wade.

Mr. Stupak and his Democrat followers have now clarified that you cannot be pro-life and be a Democrat. If abortion was truly their biggest issue, they wouldn’t willfully align themselves with the Party of Death. This vote will expose the myth of the ‘pro-life Democrat.’

With this single vote, the Democratic Party will divide our nation into the Party of Death and the Party of Life, and future elections will never be the same.”

“The executive order is not law; it can be changed by the next administration, it can be overturned by court order.”

For immediate release:
Sunday, March 21, 2010

For more information:
Derrick Jones, (202) 626-8825 or
(202) 642-1675 (mobile)
mediarelations@nrlc.org

Statement by the National Right to Life Committee
on abortion “deal” on health care legislation

WASHINGTON — (Sunday, March 21, 2010, 6 PM EDT) –  In response to today’s announcement regarding an agreement between Rep. Bart Stupak (D-Mi.) and President Obama on the pending health care bill (H.R. 3590), the following statement was issued by the National Right to Life Committee (NRLC), the federation of right-to-life organizations in the 50 states:

The National Right to Life Committee (NRLC) remains strongly opposed to the Senate-passed health bill (H.R. 3590).  A lawmaker who votes for this bill is voting to require federal agencies to subsidize and administer health plans that will pay for elective abortion, and voting to undermine longstanding pro-life policies in other ways as well.  Pro-life citizens nationwide know that this is a pro-abortion bill.  Pro-life citizens know, and they will be reminded again and again, which lawmakers deserve their gratitude for voting against this pro-abortion legislation.

The executive order promised by President Obama was issued for political effect.  It changes nothing.  It does not correct any of the serious pro-abortion provisions in the bill.  The president cannot amend a bill by issuing an order, and the federal courts will enforce what the law says.

To elaborate:  The order does not truly correct any of the seven objectionable pro-abortion provisions described in NRLC’s March 19 letter to the House of Representatives, which is posted here:  www.nrlc.org/AHC/NRLCToHouseOnHealthBill.pdf.

Regarding Community Health Centers (CHCs), NRLC has documented the problem created by H.R. 3590 here:  www.nrlc.org/AHC/NRLCMemoCommHealth.html.
Prof. Robert Destro, a professor of law and former dean of the Columbus School of Law at the Catholic University of America, and an expert on abortion-related litigation, has sent lawmakers a letter explaining why the bill opens the door to direct federal funding of abortion in Community Health Centers:  www.nrlc.org/ahc/DestroLetterToStupakOnCommHealthCenters.pdf.

Prof. Destro clearly explains why it is the statutory language that will govern.

Regarding the new program to provide tax credits to purchase private insurance, the executive order merely tinkers with the formalities of a bookkeeping scheme under which federal subsidies will pay for plans that cover elective abortion — a break from the longstanding principles of the Hyde Amendment.

The order does nothing at all to mitigate the other abortion-related problems described in the NRLC letter, dealing with bill provisions that create dangerous regulatory mandate authorities, revise Indian health programs, and create pools of directly appropriated funds that are not covered by existing restrictions on funding of abortion.  Nor can the order correct the omission from the pending legislation of the necessary conscience-protection language that had been included in House-passed health care legislation last November (the “Weldon language”).

For additional information regarding the abortion-related components of the legislation, and NRLC’s assessment of the gravity of these issues, please refer to the March 19 letter linked above, and other materials posted on the NRLC website at www.nrlc.org/AHC/Index.html.

For interviews on this issue, please call the NRLC Communications Department at (202) 626-8825.

Pro-life Dems thinking that the Stupak-Obama deal is a good thing may want to reconsider.