Our campus ORGL/COML ethics class analyzed the recent U.S. Department of Health and Human Services (HHS) decision to require most religious institutions to be included in the federal mandate to pay for coverage of contraception, sterilization and two potential abortifacients. Our class was divided into five groups representing the following ethical perspectives: utilitarianism, Kantian Categorical Imperative, Rawlsian principles of justice, Communitarianism, & Altruism (love your neighbor). Groups were required to analyze the HHS mandate from their assigned perspective prior to adaptation of the rule, and:
- Define the issue and/or ethical issue(s) at hand
- Gather the facts
- Identify alternative courses of action
- Project probable consequences, while explaining advantages & disadvantages of their assigned perspective.
UTILITARIAN PERSPECTIVE
ReplyDeleteThe proper course of action is the one that maximizes the “overall happiness.”
The moral worth of an action is determined only by its resulting, outcome, and that one can only weigh the morality of an action after knowing all its consequences.
PHASE 1: Recognize the Issues
Ethical Issue: Is it more important to supply contraception to females insured through religiously affiliated organizations or is it more important to protect the religious beliefs of a greater group of individuals? Which brings about the greater good?
Competing Principles/Values At Stake:
• Women’s Preventative Medicine—contraception specifically
• Religious values and dogma
• Separation of Church and State
Where Do We Stand On This: The separation of Church and State and the protection of religious beliefs.
PHASE 2: Get the Facts
Relevant Facts:
• Today, nearly 99 percent of all women have used contraception at some point in their lives, but more than half of all women between the ages of 18-34 struggle to afford it (White House Fact Sheet on Contraception (White House Fact Sheet on Contraception (WHFS), 2012).
• The policy also ensures that if a woman works for a religious employer with objections to providing contraceptive services as part of its health plan, the religious employer will not be required to provide, pay for or refer for contraception coverage, but her insurance company will be required to directly offer her contraceptive care free of charge (WHFS, 2012).
Stakeholders:
• Women who work in religiously affiliated organizations that oppose contraception.
• Administration of religious institutions that oppose contraception.
• U.S. Government.
• Individuals who have religious beliefs—against the use of contraception.
• Individuals who have religious beliefs—feel the government is overstepping its bounds.
PHASE 3: Identify Alternative Courses of Action & Consequences
Government to be more respectful of religious rights and omitted religious institutions from this law.
• Religiously affiliated organizations would feel respected.
• Organizations not omitted (non-religious) could feel as though they were not given the same consideration or option to be omitted from the stipulations of the law.
Identify alternative distribution methods for contraception.
• Everyone who wants or needs contraception will have access to it, while protecting religious rights.
• No consequences to the majority.
Utilitarian Viewpoint
Pros
-Allows for quick decision-making. Based solely on numbers.
-Easy to understand—simplistic.
-Forces us to examine the outcomes of our decision.
Cons
-Limited emotion, sympathy, or empathy allowed—only for the majority. Based solely on numbers.
-Consequences are difficult to measure, identify, and evaluate.
-May have unanticipated outcomes.
Altruism “The Golden Rule” Perspective // Ryan and the Ladies
ReplyDeleteDEFINE ETHICAL ISSUE: By requiring all insurers and employers to cover reproductive health care, organizations that have an ethical objection to contraception, etc. are forced to disregard their fundamental beliefs.
THE FACTS: On January 20, 2012: U.S. Department of Health and Human Services Secretary Kathleen Sebelius released a statement that issued “an interim final rule that will require most health insurance plans to cover preventive services for women including recommended contraceptive services without charging a co-pay, co-insurance or a deductible. The rule allows certain non-profit religious employers that offer insurance to their employees the choice of whether or not to cover contraceptive services.” Cardinal-designate Timothy Dolan of New York, president of the U.S. Conference of Catholic Bishops (USCCB) criticized the rule for forcing individuals to violate their conscience.
ALTERNATIVE COURSE OF ACTION: Universal health care that allows people to become involved to select ranges of services.
ADVANTAGES:
• Tailored to individual needs
• More fiscally sound system
o Eliminate the gaps of uninsured individuals who rely on expensive emergency care
• Relief for employers
• Eliminates religious objection; some level of heath care for all
• Healthier, happier society
DISADVANTAGES:
• Requires a restructuring of the entire health care system
• Not medically-based, cost/benefit analysis
• Potential negative effects on other industries (insurance companies, lawyers, pharmaceutical companies)
• Even at a supplement, there will still be a great cost to tax-payers to cover unemployed, disabled, etc.
o Altruism: Everyone should pitch in to the amount they are able, not that they are willing.
Contraception case – Communitarian Washington State
ReplyDeletePhase I
1. Define the issue at hand? Is there an ethical issue?
a.The issue is if it is ethical for the federal government to mandate all employers to provide contraceptives.
Yes.
2. Are there competing principles and/or values at stake?
a.Healthcare for all vs. religious freedom.
3. Where do you stand on this issue?
a. A community must better the health/well-bing of all in the community as opposed to an individual’s rights.
From a communitarian perspective, the law would be better if there was universal health care in Washington
State.
Phase II
1. Relevant Facts
a.Known Relevant Facts
i.In the past employers were not required to provide contraceptives in their healthcare. Now they must.
ii.Obama-care has a mandated that all individuals get health insurance.
iii.Many religions are against contraceptives or abortions.
iv.Recently employers have been required to provide healthcare.
v.Many faith-based organizations including Universities, hospitals, non-profits, etc. must now provide
healthcare that may undermine their doctrines or principles.
b.Facts that are not known
i.Would there be a religious freedom backlash and what would that look like?
ii.Exactly what happens if employers are to provide healthcare that includes contraception?
c.Do I know enough to make a decision?
i.Yes.
2. What individuals and groups have an important stake in the outcome?
a.Citizens of the state.
b.Employers of the states
c.Religions in the state.
3. Are some concerns more important? Why?
a.From Washington State Communitarian perspective the right of women to get healthcare would be important. The
law does not force people to take contraceptives. It just forces entities to provide payment for contraceptives.
4. What are the issues related to sympathy/empathy?
a.This is a highly emotionally charged issue from both perspectives.
b.We feel for the organizations that would have to compromise their values.
Phase III
1. Identify Alternative Courses of Action
a.Organizations must fund reproductive health but they do not have to fund abortions.
b.Provide a universal health care to all organizations. Therefore, organizations would not have to worry about
their organization providing contraceptives.
c.Organizations must provide reproductive health, except for religious organizations.
Phase IV
1. Probable consequences
a.The best solution is universal healthcare, which would provide universal access and allow those, who want
contraception, to get it.
b.In many ways this ships the frustration now from individuals to the entire tax base. It would be a difficult
thing as it would completely change the way health insurance is funded.
2. What are some advantages and disadvantages
3. Alternatives (advantages/disadvantages)
a.Organizations must fund reproductive health but they do not have to fund abortions.
i.Advantage is it separates contraceptives and abortions
ii.Disadvantage is that organizations may still be opposed.
b.Provide a universal health care to all organizations. Therefore, organizations would not have to worry
about their organization providing contraceptives.
i.Advantage the organizations don’t have to worry any more.
ii.Disadvantage is that the public is now fund reproductive health, and this is very controversial.
c.Organizations must provide reproductive health, except for religious organizations.
i.Advantage is that it compromises between providing women’s health
ii.Disadvantage is that some well-qualified women may not join the religious organizations.
4. Are you satisfied with your decision through the communitarian perspective?
a.Yes. The Washington State perspective would support a universal healthcare perspective.
Rawlsian Justice Ethics: Justice as Fairness, as considered behind the veil of ignorance (http://en.wikipedia.org/wiki/Veil_of_ignorance)
ReplyDeletePhase 1:
The issue at hand- Everyone should have the opportunity to chose what's right for their health.
Competing Rawlsian Principle- Everyone has access to healthcare or no one has access to healthcare/Right to religious freedom vs. right to healthcare
Rawlsian Stance: Equal healthcare for everyone, job shouldn't dictate access.
Phase 2:
Facts: Prior to bill, religious institutions did not have to provide contraception. 99 percent of women use/have used contraception. 70 percent of catholics use contraception.
Individuals/groups: Women, insurance companies, religious people and leaders. Minority/Marginalized voices (women) most important.
Issues related to sympathy/empathy: Religious views. Sympathy for contraception providers.
Phase 3:
Alternative courses: No healthcare for anyone (no contraception for anyone)/exact same healthcare plan for every person/option to "opt" out, insurance companies pay regardless/only those who can afford contraception care.
Phase 4:
The Rawlsian perspective would lean towards the current mandate: Employers must provide/if they opt out, insurance companies must provide.
Pros/Cons: Equal access, freedom to choose, freedom of religion/For the very religious, the unborn child (fetus) does not have equal rights.
Something Dr. Popa said on our first day of class resonated with me today. He said there is no such thing as, "it's just semantics...". Words are indeed selected for a reason. Contraception literally means the prevention of conception. That is the definition. Therefore a drug or procedure used to address other medical issues, or conditions that as a possible side effect inhibits or prevents conception, is NOT, by definition a contraception. Conversely, a drug or procedure used as a contraception has but one purpose, prevent conception. In this context the arguments that were raised that is a "women's health issue" I suggest are unfounded. This is an issue of sex without concern of conception. If it were a women's health issue, than the drug would not be a given as a contraception, it would be give to treat whatever medical issue that it is FDA approved to treat, and therefore no issue. Just a thought.
ReplyDeleteHey Ron,
DeleteI'm not that smart of a guy when it comes to this sort of stuff. I guess my thought would be that it could be a women's health issue if a particular woman for certain health reasons should not get pregnant but still desires intimacy in her life. Just a thought:)
Contraceptions go beyond the prevention of conception. I think it is misinformed to say that the only use for contraceptions is to prevent conception. Contraceptions initial use was for the prevention of conception; however, with the shift away from the late 1800's, contraceptions have been used in multiple women's health issues that save lives on a daily basis OUTSIDE OF SEX, including mine. If you have any further questions regarding the use of contraceptions to prevent health issues outside of sexual promiscuity, in which the FDA cannot assist in, I would be happy to list them.
Delete1. According to the Guttmacher Institute only 42% of women who use oral contraception (the pill) do so exclusively for birth control. 58% do so for medical reasons ranging from treatment of ovarian cysts to acne. The average out-of-pocket cost annually for prescription oral contraception is between $600 and $1200 per year. This is out of reach for many women.
Delete2. Most religious organizations are far more opposed to abortion than they are contraception. The majority of studies show that unwanted pregnancy is the major contributor to abortions, and that consistent and correct use of contraception drastically reduces unwanted pregnancy. Thus, use of contraception reduces abortions.
I agree with Caitlin and Searcher. I have to admit that my knowledge of social issue of contraception in the US is rather limited. Nonetheless, thanks to US organizations, especially USAID, that sponsor family planning projects in developing countries that I am better aware of social aspects of contraception in some of those countries. What I find interesting is that such organizations are getting tremendous support in their projects in developing countries. The west, US in particular, introduced and educated developing countries about artificial contraception and they are well acknowledged for their efforts. I have to credit those organizations that sponsored such educational projects in Nepal for my knowledge on artificial contraception. I find it ironic that people in the US still have hard time understanding/accepting the essential use of contraception while US organizations have been educating people around the globe on that topic.
DeleteHey Satish,
DeleteI can understand the reservation to not promotet the use of contraception in certain circumstance perhaps jr or senior high schools and perhaps other settings. However, as has been noted, prevention is not even close to the only reason for contraceptives, and therefore, believe that women do have a right to it. Also, I completedly agree with the pragmatics of contraception and have read that abortions in many countries inculding the U.S. decreased when President Clinton came into office in the 90s. He supported contraceptive funding for the nation and worldwide with the hope of reducing abortion rates.
Just wanted to weigh in briefly on this issue, with some specifics. I agree with Ron's point that if we define this as a contraception issue specifically, then it does not have larger implications for women's health. Unfortunately the terminology we choose to utilize does not change what individual women are taking this medication for, nor does it change the actions of the many medical professionals who prescribe the pill for non-contraceptive reasons.
DeleteAn article I found here (http://hcp.obgyn.net/contraception/content/article/1760982/1903701) lists these specific benefits beyond contraceptive use:
(i) improving the menstrual cycle
-reducing the pain associated with periods
-reducing the total number of days of menstrual flow
-lessening the chance of anemia
(ii) preventing certain benign conditions
-decreasing problems related to breast disorders such as fibrocystic changes and fibroadenomas
-decreasing a woman’s chance of developing certain pelvic infections
-decreasing the occurrence of ectopic, or tubal, pregnancy
(iii) the prevention of gynecologic cancers.
Given that a woman could be taking this medication for any of the above reasons, and that in many cases, doctors prescribe it to address such issues, it is short-sighted to view the issue only through the lens of "birth control".
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ReplyDelete• Define the issue and/or ethical issue(s) at hand - The mandate is a “violation of religious freedoms” and in essence is “a war on religious liberty and the Catholic Church.”
ReplyDelete• Gather the facts – “The Catholic bishops … wholly reject the president's accommodation, arguing that self-insured religious employers will still be forced to pay for contraception. They want the mandate rescinded in its entirety, so that even a Catholic person who owns a non-religious business can refuse to cover contraception for his or her employees.”
o This law has been actively used for quite some time; however, “it is new in that [President Obama's] policy … covers employers with less than 15 employees and with no copay for the individual.” This rule has actually been around since 2000.
o Measures introduced recently in Idaho, Missouri and Arizona would go beyond religious nonprofits and expand exemptions to secular insurers or businesses that object to covering contraception, abortion and sterilization.
o Speaking at the National Religious Broadcasters convention in Nashville, Family Research Council President Tony Perkins said more than 2,500 pastors and evangelical leaders have signed a letter to President Obama asking him to reverse the mandate.
• Identify alternative courses of action
The government has to be very respectful of people’s and groups religious rights. In the future they need to be more careful that they do not infringe upon the right that their way is right without taking into consideration on how their view of things differs from everyone else and how the ramifications of their decision can greatly deter people and force them to change their mind on how they are going to vote (especially in an election year where every vote counts).
• Project probable consequences, while explaining advantages & disadvantages of their assigned perspective.
I am in favor of a healthcare which is an extremely important item. However, the fact that they are saying that institutions mandatorily must provide birth control without taking into consideration how the religion organizations feels about the issue is what has brought about so much fervor.
Advantages:
• Like Baden has already written, .it has provided a means of health care to all organizations.
• This decision forces individuals and religious groups to closely examine the outcome of their decision.
Disadvantages:
• If a religious organization is against the issue of birth control in the first place, the decision does not take their beliefs into consideration.
• Supersedes personal interests
• The consequences of the decision are going to be very difficult, time-consuming, and cost prohibitive to measure and identify how this has affected people.
• The leaders (decision-makers) of organizations are going to have come up with some very hard decisions how they are going to address the issue, will they be in favor of the issue, and will they accept the fine that will be enforced if they don’t back the decision.
Where do I stand on this issue? Suffice it to say, I am not in favor of this decision. The government has stuck their nose in a place it doesn’t belong and they overstepped their boundaries by mandating this decision.
Under this philosophy, if one is morally opposed to war, then he/she should not have to pay taxes that might be used to support war.
DeleteWhen does the duty to the general welfare of society take precedence over individual ethics of virtue?
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ReplyDeleteThis comment has been removed by the author.
ReplyDeleteGroup V - Contraception Mandate (Part I)
ReplyDeleteYes, there is an ethical issue.
Ethical issues:
• The principle of religious liberty and an individual's right to avoid violating their conscience
• Women’s right to preventative healthcare and society’s obligation to provide that
• Ability of government to interfere with individual and/or group faith practices
Competing principles/values:
• Bulk of the people who will be affected are not represented in the decision-making
• Sincerity of the motivation/intent (or are women being used as a means to an end)
• Religious liberty and the freedom to live without violating one’s own conscience
• Religious conviction on the issue of birth control
We as a group are conflicted because we disagree with Kant.
Facts of the case:
• Obama’s administration instituted a policy which grants free preventive care (including contraceptive services) to women through their employer-provided health insurance
• The Catholic church, which opposes birth control, balked at the policy, citing religious freedom
• A media debate ensued, with some calling on the government to modify its policy
• Previously, In 2010, Pope Benedict XVI stated that: “Justice requires guaranteed universal access to health care”
Facts not known:
The views of women employees (given that “99% of women” have made use of contraception before)
The views of others in the Catholic church besides the Bishops in question and the Pope
We believe that we do, however, know enough to make a decision.
Which individuals and groups have an important stake in the outcome?
• Women in the United States
• Religious organizations
• Hospitals, Schools and other organizations affiliated with the Catholic church
Which concerns are most important? Why?
• Religious liberty and freedom conscience
• Women’s health
Religious liberty and freedom of conscience is most important
• The freedom of religion and separation of church and state is laid out in the American Constitution
• The issue concerns birth control and not health care as a whole
• The loss of freedom of religion has far greater consequences
Issues related to sympathy/empathy in decision making?
• There are limits to the degree to which men can empathize with women
• Forcing those of certain religions to compromise their consciences
Group V - Contraception Mandate (Part II of response)
ReplyDeleteAlternative Courses
• Current compromise, which exempts churches and religiously-affiliated organizations
• Engage in dialogue with the Catholic church to change their policy on birth control (Question their authority to determine individual freedoms)
• Suggest to the Catholic church that they establish alternative institutions to cater to individuals who disagree with the principle
Probable Consequences
• Have an opt-in policy which allows organizations to choose
o Allows freedom of conscience to be respected
o Allows some organizations to maintain religious convictions whilst others can bend
o Provides contraceptive health care for some of the women who desire it
• Engage in dialogue with the Catholic church
o Allows for voice of the laity to be heard
o Would most likely result in Catholic affiliated organizations providing such healthcare
• Suggest to Catholic church that they establish alternative institutions
o Provides contraceptive health care for some of the women who desire it
Kantian Perspective
Kantian perspective maintains that one should “do right no matter what the consequences”. There would be a conflict between the universal principles of religious freedom (and the respect of the sanctity of human life) and caring for the health and wellbeing of members of society. Consequently, this perspective would maintain the current ruling of the Catholic Church based on the “universal maxims" involved. While our group theorized alternative courses of action we believe a Kantian perspective would not allow for these options. Instead, it would firmly maintain that the principle of religious freedom and the sanctity of human life be upheld at whatever cost.
Advantages
o Fulfilling of duty and following of established rules; clarity of conscience
o Catholic Church maintains consistency of doctrine
Disadvantages
o Inflexible; Kantian perspectives provide a unsophisticated lens which leaves no room for exceptions or complexity
o As a consequence, the health and wellbeing of women suffers
It is interesting with Kant because it depends on what universal truths are at stake. Is it women's health? Is it religious freedom? I would argue that a Kantian could stand for an egalitarian approach (universal health care) no matter the cost.
DeleteQuestion: When does the religious freedom of one group or individual supercede the equal protection of another group or individual? Does ones right to religious freedom allow ones religious and moral belief to be imposed upon others in a non-religious setting?
DeleteThe Senate had a major defeat today on this controversary bill which basically turns back the clock and almsot puts things back the way that they were. Below is a quote from the msnbc headlines (http://nbcpolitics.msnbc.msn.com/_news/2012/03/01/10548839-senate-defeats-limit-on-birth-control-coverage) that really captures the ethic issue at hand from my perspective.
ReplyDeleteBlunt and his allies said it was necessary to protect the First Amendment conscience rights of religiously affiliated employers to not pay for medical services such as contraceptives that they oppose on moral grounds.
Jehovah Witnesses are morally and religiously opposed to blood transfusions - so if I work for a company that is owned by Jehovah Witnesses, they could exclude any procedures that may require blood transfusions.
DeleteChristian Scientists are opposed to nearly all medical care in favor of prayer. If the company I work for is owned by Christian Scientists, should they be allowed to not provide health care insurance and require me to go to a Christian Science healer?