January Note From the President and CEO: The Paradox of Religious Freedom in America

When it comes to end-of-life care, sometimes freedom of religion requires freedom from religion.
January 20, 2023

At Compassion & Choices, we believe that people have the right to die in a way that is consistent with their personal priorities and values — whatever their beliefs are. And when it comes to end-of-life care, sometimes freedom of religion requires freedom from religion.

As such, I’ve been thinking a lot about religion and personal freedom this month. January 16 was Religious Freedom Day, the same day we celebrated Rev. Martin Luther King and his faith-based fight for civil rights. At the end of the month, we recall what can happen when those in power demonize a different faith: January 27 is International Holocaust Remembrance Day.

American values are rooted in the ideal of religious freedom, dating back to the Puritans. Yet our lived history is rooted in the reality of slavery, oppression and forced assimilation. Of course, it’s not just the United States. The same paradox has undergirded human society for millennia: We seek to build one peaceful, law-abiding civilization by conquering, coercing and co-opting others. It’s the old us vs. them, right vs. wrong mindset, where there’s only one acceptable viewpoint — the dominant viewpoint.

This is the mindset our movement’s opposition appears to have: One religious framework is used to make personal healthcare decisions for all patients. This forces too many people to endure end-of-life care that’s inconsistent with, and many times directly contrary to, their own values. Not to mention prolonging their physical and emotional suffering — and the impact on their loved ones.

Patients’ options for end-of-life care are limited by some religious institutions; this harsh reality is particularly true within Catholic health systems, which comprise the largest group of nonprofit medical providers in the nation. The care provided at these 600+ hospitals and 1,600 long-term care and other health facilities is dictated by the U.S. Conference of Catholic Bishops’ Ethical and Religious Directives (ERDs) — which are based not on healthcare best practices or medical ethics, but on religious doctrine.

The ERDs strictly prohibit practitioners from providing medical aid in dying. But it doesn’t stop there: The ERDs also include such dogmatic directives as telling physicians whose patients suffer with intractable, untreatable pain to help them “appreciate the Christian understanding of redemptive suffering.”

Suffering — how much we want to endure, and whether it has religious or other meaning  — is a personal matter. It’s no surprise that 71% of Americans want their own personal healthcare decisions to take priority over a healthcare facility’s religious values.

Unfortunately, many people (especially if they’re from medically underserved communities) simply do not have a choice; religiously affiliated healthcare is the only option. And that trend is only increasing, as Catholic health systems are acquiring or merging with more and more rural and low-income hospitals/health systems that have gone bankrupt due to the pandemic.

When it comes to personal healthcare decisions, the current Supreme Court has proven that it favors conservative Christian beliefs over individual autonomy. This is filtering down to state-based legal decisions: Religious healthcare systems regularly withhold accurate, candid information about the kinds of care they refuse to provide — without any repercussions for their lack of transparency. In fact, many once-secular clinical outlets retain their nondenominational name, meaning that patients don’t even realize their medical care is now being dictated by (usually) the Catholic Church.

This is why Compassion & Choices has joined forces with two national and several state coalitions to tackle the problem of the outsized influence of religious dogma in U.S. healthcare. Our legal team also is combating the oppositions’ attempts to prioritize religious values over a dying patient’s rights, including cases seeking to:

All of this centers around the same overriding question: Whose values matter when a person is approaching death? Is it a religious institution? The government? An insurance company? Or the person whose life is ending?

To me and for Compassion & Choices, the answer is clear: Patients should be the decider in their end-of-life care.

Compassion & Choices
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