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.

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. Qualitative Research Interviews
— 100 subjects at Catholic
and Jewish Hospitals,
and the Greater Boston
Interfaith Organization
— IUPUI/Clarian IRB
Approval: 0506-65B

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. 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. 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. 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. 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. 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. 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. 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