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D A V I D C R A I G
P R O F E S S O R , R E L I G I O U S S T U D I E S
I U S C H O O L O F L I B E R A L A R T S
I N D I ...
Qualitative Research Interviews
—  100 subjects at Catholic
and Jewish Hospitals,
and the Greater Boston
Interfaith Organ...
Argument
1.  Can Organizations Claim Free Exercise Protections?:
Yes, but on the basis of an integrated religious mission,...
Do Organizations Exercise Religion?
Justice Alito’s either/or:
either only “natural persons” or
“natural persons” and all ...
Justice Brennan’s Concurrence in Amos
“For many individuals, religious activity derives meaning
in large measure from part...
What Distinguishes Religious Employers?
HHS’ “religious employers” (churches, temples,
mosques and their auxiliaries) are ...
Balancing Religious Mission and Public Mandates
E.g., of Catholic community benefits practices—
two core values of service...
Accommodating Catholic Hospitals
—  Precedence: Community benefits policy teaches wisdom
of authorizing Catholic health c...
Adjudicating Sincerity of Mission Integrity
—  Property Use Approach: “Religious purpose is not determined
solely by the ...
Three Proposed Tests
—  Associational buy-in test: employees and customers
demonstrably affirm corporate religious missio...
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David Craig, "Mission Integrity Matters: Toward a Consistent Approach on Catholic Health Care Values and Public Mandates"

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Religion and medicine have historically gone hand in hand, but increasingly have come into conflict in the U.S. as health care has become both more secular and more heavily regulated. Law has a dual role here, simultaneously generating conflict between religion and health care, for example through new coverage mandates or legally permissible medical interventions that violate religious norms, while also acting as a tool for religious accommodation and protection of conscience.

This conference identified the various ways in which law intersects with religion and health care in the United States, examined the role of law in creating or mediating conflict between religion and health care, and explored potential legal solutions to allow religion and health care to simultaneously flourish in a culturally diverse nation.

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David Craig, "Mission Integrity Matters: Toward a Consistent Approach on Catholic Health Care Values and Public Mandates"

  1. 1. D A V I D C R A I G P R O F E S S O R , R E L I G I O U S S T U D I E S I U S C H O O L O F L I B E R A L A R T S I N D I A N A U N I V E R S I T Y - P U R D U E U N I V E R S I T Y I N D I A N A P O L I S ( I U P U I ) Mission Integrity Matters: Toward a Consistent Approach on Catholic Health Care Values and Public Mandates
  2. 2. Qualitative Research Interviews —  100 subjects at Catholic and Jewish Hospitals, and the Greater Boston Interfaith Organization —  IUPUI/Clarian IRB Approval: 0506-65B
  3. 3. Argument 1.  Can Organizations Claim Free Exercise Protections?: Yes, but on the basis of an integrated religious mission, not individuals’ religious beliefs 2.  How Should Religious Mission and Public Mandates Be Balanced?: Granting religious health care providers latitude to meet public mandates in light of their core values makes historical and pragmatic sense 3.  How Might Mission Integrity Be Judged?: Multiple constituencies must actively affirm an explicit religious mission
  4. 4. Do Organizations Exercise Religion? Justice Alito’s either/or: either only “natural persons” or “natural persons” and all types of “artificial persons” exercise religion Alito’s association of religious believers (e.g., owners) Ginsburg’s “community of believers” Litmus test: unanimity of religious beliefs
  5. 5. Justice Brennan’s Concurrence in Amos “For many individuals, religious activity derives meaning in large measure from participation in a larger religious community. Such a community represents an ongoing tradition of shared beliefs, an organic entity not reducible to a mere aggregation of individuals. Determining that certain activities are in furtherance of an organization's religious mission, and that only those committed to that mission should conduct them, is thus a means by which a religious community defines itself. Solicitude for a church’s ability to do so reflects the idea that furtherance of the autonomy of religious organizations often furthers individual religious freedom as well.” Corp. of Presiding Bishop of Church of Jesus Christ of LDS v. Amos (1987)
  6. 6. What Distinguishes Religious Employers? HHS’ “religious employers” (churches, temples, mosques and their auxiliaries) are not distinguished by employing and serving only co-religionists. Instead their mission is settled by authoritative doctrine (to which participants assent). Mission is not articulated through internal dialogue or negotiated with external partners.
  7. 7. Balancing Religious Mission and Public Mandates E.g., of Catholic community benefits practices— two core values of service to the poor and common good Losing money on a minimum charity care threshold competes with other community priorities: 1.  Building community stakeholder coalitions 2.  Providing money-losing health care services 3.  Pioneering cost-effective protocols that improve health outcomes in poorer populations 4.  Investing in healthy communities (housing, economic development, environmental improvements, etc.)
  8. 8. Accommodating Catholic Hospitals —  Precedence: Community benefits policy teaches wisdom of authorizing Catholic health care providers to meet public mandates in light of their integrated mission. —  Pragmatism: The Affordable Care Act relies on public mandates—individual and business mandates, state health insurance exchanges, minimal essential benefits— to further governmental interests in equity, inclusion, transparency, stewardship and shared responsibility. Requires willing participation by religious providers.
  9. 9. Adjudicating Sincerity of Mission Integrity —  Property Use Approach: “Religious purpose is not determined solely by the professed motives or beliefs of the property’s owner. A court must also take into account the facts and circumstances regarding how the property is actually used.” Provena Covenant Medical Center v. Dept. of Revenue (2010) —  Multiple Constituency Approach: “The court fails to comprehend the possibility of a corporation that is both separate of its owners and religiously expressive in its own right at the same time...a corporation’s religious identity flows not simply from the wishes of its owners but rather from the confluence of a multitude of constituencies.” Ronald Colombo, “The Naked Private Square” Hous. LR (2013)
  10. 10. Three Proposed Tests —  Associational buy-in test: employees and customers demonstrably affirm corporate religious mission, e.g., through employee training and commercial advertising —  Worker welfare test: employees holistically benefit from corporate religious mission, e.g., through compensation, benefits, safety, etc., policies to which owners and managers are held accountable —  Public service test: corporation advances public interests through corporate religious mission, e.g., by committing service lines and/or revenues to identifiable public needs

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