The Obama administration’s decision regarding Catholic institutions and coverage for reproductive health has stirred up a firestorm of claims that the policy restricts religious freedom. That’s true: the policy does restrict religious freedom to an extent. But while freedom of religion is surely a principle Americans hold dear, it is not absolute. Religious rights end where they infringe on someone else’s liberty, religious or otherwise.
To take a particularly stark example, Warren Jeff’s sincere religious beliefs led him not only to take several wives, but to take under-aged wives and to encourage his followers to do the same. The states of Utah and later Texas, both known for their devout citizens, responded by sentencing Jeffs to prison for his role in the sexual assault of children. If there was an outcry from mainstream religious groups in support of Jeff’s religious freedom, I must have missed it. On the contrary, the state enjoys widespread support, including among religious people, for intruding on this particular religious practice.
The health care arena also provides instructive examples of the recognized limits to religious freedom. Parents may not decline life-saving treatment for their minor children, even when this treatment contradicts their religious views. Ex-Christian Scientist Rita Swan suffered the death of her son when she delayed care on the advice of a religious advisor. Swan has powerfully advocated for laws that do yet more to prevent unnecessary child deaths based on religious refusal of treatment. In both cases above, people were denied the right to impose their religious views on those who lacked the ability to object.
Looking to the context of health insurance, we may ask if there are or should be other circumstances in which employers are permitted to deny coverage based on sincere religious beliefs. The Mormon faith prohibits the use of cigarettes and alcohol, but should a Mormon employer be forced to provide insurance coverage for employees who smoke and drink and then rack up vast medical bills as a result? The cost of illnesses related to cigarettes and alcohol addiction is staggering.
Imagine the economic and competitive advantages for a large corporation, say Marriott, if it was freed from the obligation to cover the consequences of alcohol and tobacco use because of an affiliation with the Mormons. And of course no mainstream religion, nor indeed any mainstream corporation, supports the use of illegal drugs, the treatment costs for which are daunting. Could a religious institution describe its ban on the use of illegal substances as a central tenet of its faith and then demand a waiver in coverage? Again, the economic benefits would align so well with this religious view that we might see a startling increase in corporate religiosity.
So far religious institutions do not have the right to deny insurance coverage for health issues, other than reproduction, that arise from practices they find objectionable. Nor should they. Catholic and other religious institutions employ many who are not Catholic. A religious institution may be the largest employer in a community, and only a minority of employees may be members of that faith – and some of them may not adhere to all of its tenets.
If an employer can refuse to cover the health consequences of practices that offend its religion, where do we draw the line? Many health care problems, from hepatitis to throat cancer to end-stage lung disease, arise in part from practices banned by various religions, or even by law. Religious institutions are free to hate sin, but the wages of sinners must include adequate health coverage.
Tia Powell is director of the Einstein-Cardozo Master of Science in Bioethics and a professor of clinical epidemiology and clinical psychiatryAlbert Einstein College of Medicine in New York.