Conscience and the Catholic Social Worker

Paul Adams

Here is the paper I just presented in Indianapolis on the significance of conscience in social work and professional ethics in general. It asks whether the discounting and trivialization of conscience in social work - a result of conceptual confusion and partisan passions - is deprofessionalizing the field by turning social workers into the moral equivalent of robots or vending machines.

Conscience and the Catholic Social Worker

Paper presented at the

Catholic Social Workers National Association 2012 National Conference

Indianapolis, July 20-22, 2012

Paul Adams

Here is a typical passage from the regular column of Director of the National Association of Social Workers (NASW), Dr. Elizabeth Clark, in NASW News, for May 2012:

In the last few months, we have seen the worst attacks on women’s rights since the passage of Roe v. Wade in 1973.  These attacks have come in many guises and from oblique directions.  They have been couched in outcries of religious freedom, conscience clauses, cost containment and paternalism.  We have seen restrictions in Plan B, the emergency contraception pill,, for younger women, a challenge to insurance coverage for working women, and proposals for required ultrasound procedures....

American women and women’s groups have not been silent during this turbulent spring.  We watched women challenge the decision of the Susan B. Komen Foundation to defund Planned Parenthood.  We were appalled....  We were further outraged by....

On the other hand, we cheered with the defeat of the Blunt amendment to allow religious groups to decline insurance coverage they morally oppose.

And so on and on, with the full stock of Democratic Party/Planned Parenthood talking points supporting their “war on women” narrative.  Such partisan, unnuanced rants in which our professional association’s executive director purports to speak, not only for all social workers but all women too, ought not, by now, to surprise us.  For a response from women for whom Clark, the DNC and Planned Parenthood do not speak, see this letter.  Nor by the unsupported and indeed counterfactual assumption that abortion and contraception are goods for women (see, for evidence to the contrary, Eberstadt’s (2012) Adam and Eve After the Pill: Paradoxes of the Sexual Revolution.

Set aside for the moment the particular issues that exercise Clark here and what still startles is the casual dismissal of all talk of religious freedom and conscience.  Such blankness of incomprehension here and consistently through NASW’s statements is a debased understanding of the very concept of conscience.  No other profession gives such short shrift to conscience or has so little regard for the conscience rights and protections of its own members.

The threats to conscience and religious freedom confronting Catholic social workers have become more evident and pressing since I submitted the proposal for this session. There has been a flood of writing about the subject covering everything from individual legal cases to the HHS mandate to the Fortnight for Freedom launched by the U.S. bishops.  

Here I will limit myself to developments most directly related to social work practice and to the threat posed to conscience by the very way in which the social work literature frames the discussion of conscience exemptions and conscientious objection.  As Catholic social workers, I want to suggest, we need to understand some important distinctions in the realm of conscience in order to argue our case with colleagues and legislators, as well as to consider our own options.

Threats

Catholics and others in social work and related fields who adhere to the religious orthodoxy of the Judeo-Christian tradition in matters of life, death, sex and marriage face threats to conscience at every level.  The secular-liberal orthodoxy in these areas aims not at tolerance or pluralism, but seeks a monopoly in the public square (George, 2002)

In 2009 Julea Ward was dismissed from her counseling program at Eastern Michigan University after she sought to refer rather than treat a potential client who was seeking counseling about a homosexual relationship.  The university’s insistence that Ward needed “remediation” to help her abandon her beliefs about homosexual behavior and act against her conscience led to her dismissal from the program and resulted in a series of university and judicial hearings and appeals.  In June 2012, the Michigan House passed Bill 5040, known as the Julea Ward Freedom of Conscience Act, prohibiting religious discrimination against college students studying counseling, social work, or psychology.

In its review of ten social work education programs, the National Association of Scholars found many examples of the coercion of student consciences, legitimated by a narrow reading of the NASW Code of Ethics.  The cases involved requiring students to advocate and lobby for positions to which they were opposed in principle and as a matter of conscience.  Again and again, we find students coerced into a morally degrading performance that requires public avowal of belief contrary to their own belief, conscience, and faith.

The issue of coercing the conscience of professionals in the health and helping professions has come to the fore in recent years as a result of the discovery, invention, or promulgation of new rights in matters of life and death, sex, marriage, and family.  Behaviors that were illegal or socially stigmatized for millennia have been declared legal and become rights.  This is not simply a victory for tolerance against the views and values of the majority of the population.  It is a claim, supported by the force of law, for equal recognition and respect, subject to anti-discrimination measures equivalent to those that apply in the case of sex and race.

For more than two millennia, physicians have sworn by the Hippocratic Oath not to engage or collude in practices like abortion, euthanasia, or assisted suicide.  In the wake of the egregious violations of the Hippocratic ethic by Nazi physicians, the World Medical Association’s 1948 Physician’s Oath affirmed “I will maintain the utmost respect for human life from the time of conception, even under threat." The legally binding United Nations Declaration of Human Rights and the 1959 UN Declaration of the Rights of the Child affirm the rights of the child before as well as after birth (Joseph, 2009).

With astonishing speed, all these and other legal protections have been swept away either in letter or spirit.  UN officials have been criticized for attempting to pressure sovereign member states to establish abortion as a legal right (Tozzi, 2008). 

Hippocratic and other oaths have been revised to eliminate the prohibitions on killing—whether through abortion, euthanasia, or assisted suicide.  And, most disturbing of all, health care providers have transformed their own professional ethics from forbidding abortion and other life-terminating measures to all but making direct or indirect participation in them a requirement of professional practice. 

In recent years, the threat to conscience rights has widened beyond abortion and the duties and conscience rights of physicians, nurses, and pharmacists to areas in which social workers are more directly and routinely involved.  Among these are counseling or psychotherapy and foster care and adoption, where practitioners and agencies are expected to affirm same-sex sexual relations and, in a growing number of states, same-sex “marriage,” as equivalent in moral status, social honor, and appropriateness as family environments for children, to conjugal relations between husband and wife. 

One driver of these developments, Alvaré (2012) argues, is the vigorous promotion by the Federal government of a new moral orthodoxy, an ideology she terms sexualityism or sexual expressionism.  Against what social science tells us about human happiness, as well as against the defense of religious freedom, “the government is promoting sexualityism—a commitment to uncommitted, unencumbered, inconsequential sex.”

The HHS mandate stands on this theory. In a world of easy availability of birth control and abortion, the only reason for a federal mandate for a “free” and universal supply is to try to send the sexualityism message. The White House has all but come out and said: “women of America, vote for the incumbent this presidential election year because he supports women’s equality and freedom, which he understands to include at the very least nonmarital and nonprocreative sexual expression.” Why else choose Sandra Fluke—an affluent, single, female law student, who demands a taxpayer-subsidized, 365-day supply of birth control as the price of female equality—as your spokeswoman?

The HHS mandate requiring all employers, with narrow exceptions, to provide “insurance” coverage of abortifacients, contraceptives, and sterilization, threatens the religious freedom of all Catholic employers and organizations.  My own hometown is built around a university that has made it clear it will not comply with the mandate.  Nor will the local Catholic school, the only school in town. The threat is to the existence of the whole town, which cannot survive as a Catholic community without these Catholic institutions at their heart.  

In general, either Catholic organizations will violate the Church’s authoritative teaching and effectively cease to be Catholic, or they will be closed down, sold off, or fined (that is, “taxed”) out of existence .  As Cardinal George of Chicago put it, “a governmental administrative decision now mean[s] the end of institutions that have been built up over several generations from small donations, often from immigrants, and through the services of religious women and men, and others who wanted to be part of the church’s mission in healing and education.”

One result of the stripping of these health and social service programs from the Church would be to deprive Catholic social workers of even the possibility of practicing their profession in a Catholic context, that is as part of the Church’s corporate response to the needs of the poor, sick, homeless, and oppressed - an organized activity and duty of the Church from the beginning.

Conscience

Among the health and helping professions, social work stands out for its opposition to conscience exemptions for its own members.  More than two-thirds of respondents in Sweifach’s (2011) study believed that laws protecting some health care providers should not be extended to social workers.  In contrast, and despite ongoing attacks on conscience exemptions within the professions, other fields give more weight to professional judgment and discretion in choosing whom to serve and how to serve them.  The American Pharmacists Association (2008) recognizes an individual pharmacist’s right to conscientious refusal.The AMA’s (2006) Code of Medical Ethics states that “A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve.”  According to the American Nurses Association, nurses have a right to refuse to participate in a procedure, but the conscientious objection must apply to the procedure, not the patient.  Lawyers also assert the right to refuse representation in cases they consider morally repugnant, though they seem not to have the right to exclude whole categories of clients, such as men in divorce cases (Harpaz, 1998).

In social work, in contrast, the tendency is to address the conflict in ways similar to that of the Eastern Michigan counseling program - treat or exclude the practitioner.  Tellingly, Sweifach (2011) cites the NASW code of ethics insistence on the social worker’s primary responsibility to promote the well-being of clients, as though the practitioner’s judgment of that matter were necessarily subordinate to the client’s.  “Commentators explain that when clients’ behaviors and practices conflict with a social worker’s personal morals or religious beliefs, the social worker may be in need of peer support, supervision, or values clarification training to responsibly serve clients.”  Conscience is thus reduced to “personal values,” and the professional as moral agent to a cipher.

In part, the failure of professional organizations like NASW to protect the conscience rights of their members is justified by an implicit rejection or belittling of the very concept of conscience as traditionally understood.  In its place we find a contrast of public (or professional) and personal “values.”  Here values have no intrinsic authority or foundation beyond being the subjective opinions or beliefs of those who hold them.  If this is so, then why should the personal opinions (values) of a practitioner not be subordinated to those of the state that licenses and funds the professional or institution?  

Much social work literature on the subject frames issues of conscience as a conflict between personal and professional values.  In a recent article, Sweifach (2011) gives several examples from the literature as well as himself framing the issue of conscience and conscientious objection in those terms.  For example, Linzer (1998) suggests that “in conflicts between personal values and professional values, the professional is duty-bound to uphold professional values.  Upholding professional values represents ethical action” (p.28). According to this view, it is ethical, in these circumstances, to act against your own conscience.

As Catholic social workers come under increasing pressure to cooperate with evil in the name of professional duty, the question of conscience becomes correspondingly urgent.  Recent statements from NASW, its executive director and its Legal Defense Fund, make it clear that our professional organization will not defend the conscience rights of its own members when policies they support are involved. 

Opponents of conscience exemptions give little or no weight to the gravity of requiring someone either a) to act against their conscience or b) to leave their profession or be denied admission to it and hence to its schools.  But the choice to act against your conscience can never be right.  It is to choose to do what you believe to be wrong, and in the case of abortion, gravely wrong.  For a Christian, it means to put your immortal soul in jeopardy; for a Catholic Christian, it means to excommunicate yourself from your Church and its sacraments.  

In its hotly disputed Opinion #385, entitled “The limits of conscientious refusal in reproductive medicine,” the Committee on Ethics of the American College of Obstetricians and Gynecologists (2007) takes the position that pro-life physicians must refer patients seeking an abortion to other providers, must tell patients in advance of their views though not explain or argue for them, and must in emergency cases involving the patent’s physical or mental health, actually perform abortions.  It treats conscience as one value among others, which means it can and should be overridden in the interest of other obligations that outweigh it in a given circumstance.  That is, not only the hospital or clinic, but also the individual physician, is called upon to override the physician’s conscience.

A prevalent idea of conscience, implied by this opinion and most of the social work literature, minimizes its claims by treating it as only one thing among others that the practitioner must take into account in deciding how to act.  Conscience becomes a matter of personal values that must be left at the office door when duty calls.  At least, as it is put in one formulation, professional duty trumps personal conscience.  

But this account trivializes the very concept of conscience and renders it incoherent.  It runs counter to the traditional understanding of the term, according to which conscience is the supreme and final arbiter for an individual’s actions precisely because it represents the agent’s best ethical judgment all things considered.  All things here must include considerations of what the agency or the state or professional codes of ethics tell us our duty is.  It could never be right to act against one’s own conscience.  It is hard to see how a notion of conscience as one value among others from which a professional should choose could be other than incoherent. On what ethical basis could such a choice be made?  What is to be counted after everything has been counted?

Not only has the Nietzschean term “values” become a rhetorical device for subjectivizing and relativizing moral discourse, but conscience itself has become “the ghostly inner voice telling an individual what he or she should or should not do” (Moreland, 2011, p.320).  When conscience is conceptualized as a faculty of the individual, its claims too readily become detached from judgments of practical reason about the right thing to do.  McCabe (1986, quoted by Moreland, 2011) draws the contrast with the older Catholic tradition: “Aquinas does use the word conscientia, but for him it is not a faculty or power which we exercise, nor a disposition of any power, nor an innate moral code, but simply the judgment that we may come to on a piece of our behavior in the light of various rational considerations” (p.322).

Conscience in this view is not subjective opinion, a matter of autobiography, but involves knowledge and judgment, and is thus open to rational inquiry.  It is not a conversation stopper, like the subjective preference for vanilla over chocolate ice cream.  As Moreland explains, “A person is said, then, to act in accord with a good conscience with truthful knowledge, which, in turn, habituates one into the cardinal virtues of justice, temperance, fortitude, and especially prudence” (p. 322).  For Aquinas and the Christian tradition, conscience--applying the general principles of practical reasonableness to specific circumstances--is closely linked to the classical virtues (above all prudence) acquired by experience and habituation.

We thus ought to follow our conscience not because it is a uniquely authoritative autonomous inner voice but because it is our best practical judgment of right action all things considered.  It is a necessary but not sufficient condition of acting well.  As Anscombe ([1958] 2005) puts it in her justly renowned critique of “Modern Moral Philosophy,” “a man’s conscience may tell him to do the vilest things” (p.170).

Karl Jaspers gave the example of a young German concentration guard he met in hospital at the end of WWII - the man’s conscience tortured him still because he let a Jewish boy escape instead of doing his duty of rounding him up and sending him to the gas chamber.  Our conscience is our last defense against cooperating with evil in the name of duty, but conscience can itself be wrong and direct us to do evil.  We must both follow our conscience in all matters and also form our conscience well by following reliable authorities and the advice and models of prudent persons.  As Anscombe ([nd] 2005) - in unpublished notes for a lecture - explains the dilemma,

If you act against your conscience you are doing wrong because you are doing what you think wrong, i.e., you are willing to do wrong.  And if you act  in accordance with your conscience you are doing whatever is the wrong thing that your conscience allows, or failing to carry out the obligation that your conscience says is none.  

There is a way out, Anscombe concludes, but you have to know that you need one and it may take time.  The way out is to find out that your conscience is a wrong one (p.241).

In social work we do wrong both when we act against our conscience and when we follow a badly formed conscience into evil actions thinking they are good or morally neutral.  The wrong in the second case is not that we followed our conscience, but that we failed to form our conscience correctly.  We are obliged, as John Paul II (1993) says in Veritatis Splendor, both to inform our conscience and to follow it.  We can be at fault at either stage.

Preferences and Obligations

Whether conscience is treated as one factor among several to be taken into consideration or as a subjective, non-rational inner guide or faculty, it appears reasonable in either case to reject or minimize the claims of conscience in policy and law, even when a religious motivation is claimed.  For the late political philosopher Brian Barry, conscientious objections based on religious belief are simply preferences.  He asks why some, namely religious, preferences should be privileged in law or policy over others.  Why should the state bend over backwards to accommodate the preferences of a minority? Why should laws be crafted so that individuals and their associations will never be unnecessarily coerced into violating their consciences? 

As Moschella (2012) summarizes the argument (that she proceeds to rebut) advanced by the editors of the New York Times and many others, “opposition to the [HHS] mandate seems like an attempt to impose Catholic views about contraception on the rest of the society, or an unjustified request for special treatment. Why should a minority of Catholics ... determine public policy for the entire country? Yes, the government could provide free access to contraceptives without conscripting employers to do it for them through their health plans, but why should we bend over backwards to adapt our policies to the religious or moral sensibilities of a minority?”

No-one claims that the conscience of a given individual or group always trumps other considerations in policymaking. A conscience, even one that is shaped by binding religious obligation, may be badly formed and contrary to moral truth, as when a religion requires its members to offer human sacrifice or kill nonbelievers.  In those cases, the common good requires that such believers be coerced into violating their consciences.  

But the moral integrity of persons is itself constitutive of the common good.  Absent an absolute necessity to coerce the consciences of some in order to protect public order and the rights of others, the common good also requires respecting the claims of conscience.

The blurring of the distinction between preferences and obligations is one aspect of the trivialization of conscience in much discussion on these issues.  As Moschella (2012) argues, 

[T]here is a world of difference between a law that makes me do something I don’t want to do, and a law that makes me do something I have an obligation not to do. The former is an annoyance, the latter an assault on my moral integrity. I may not want to follow the speed limit, but that doesn’t give me a claim to be exempted from the law. On the other hand, if I believe that killing animals is morally wrong, no law should force me to serve meat in my business’s cafeteria, or give my employees gift certificates to a steakhouse, even if encouraging people to eat more high-protein foods would promote public health.

Here we might add that there is also an important difference between my deciding whether or not to meet my religious obligation to attend Mass on Sundays or have my sons circumcised and the state’s compelling me to do or not to do so.

As Moschella (2012) argues, “laws that forbid individuals to act in accordance with the dictates of their consciences place a burden on those individuals that differs not only in degree, but in kind, from the sort of burden involved in forbidding someone to act in accordance with mere preferences, however strong.” Such laws distribute the burdens and social benefits of social cooperation unequally.  It is a difference in kind of burden imposed, not merely of degree.

We may see this by looking at the notorious precedent created by Antiochus IV Epiphanes in the second century B.C.  The tyrant required his Jewish subjects to eat pork and food sacrificed to idols and not to perform circumcisions.  Those who refused to violate their consciences in this way “were to be broken on the wheel and killed” (4 Maccabees 5:3).  The edict imposed a radically different burden on observant Jews than on others.  It was a gratuitous act of forced submission, a brutal assertion of secular power against a people of faith.  As Paulsen (2012) puts it, the story remains “a remarkable two-thousand-year-old parable about tyranny and conscience, about cram-downs, accommodations, deception, and adherence to principle.”  Like the HHS mandate, it was an unnecessary cram-down, a case of a government insisting “on vindicating its authority and overriding religious conscience for its own sake—purely for the symbolism of power prevailing over conscience.”

Redefining Religion

An important element of the current assault on religious freedom is the administration’s effort to redefine the place of religion in public life by reducing religious freedom to freedom of worship.  The HHS mandate promotes a false but prevalent idea of religion as a private and marginal activity, the practice of which involves only co-religionists.  Thus the state takes it upon itself to redefine religion, and to do so in ways that exclude essential elements of Christianity and other universal religions from their beginnings.  The mandate’s exemption covers only religious organizations that have religious function as defined by the state and that serve primarily co-religionists.  

From this perspective, put bluntly by the British Equality and Human Rights Commission Chief, Trevor Phillips, religious beliefs end “at the door of the temple.”  For Catholic Christianity, the duty to evangelize non-Christians and to serve the poor, sick, homeless, prisoners, widows and orphans - both Christians and non-Christians - is not an optional add-on to the free exercise of religious faith.  It has been a corporate, not just individual responsibility of the Church from the very beginnings.  

Conscience and Duty

The argument against conscience exemptions for health care and social service professionals (physicians, nurses, social workers) is typically framed as a conflict between an individual’s (or institution’s) right to decide what services or treatment it will provide and patients’ rights to treatment, which is said to imply a duty to treat. 

The client’s right to treatment, to a full range of services, may be linked to professionals’ willingness to provide them, especially in rural areas.  As the chair of the ethics committee of the American College of Obstetrics and Gynecology put it, the “reproductive health needs” of women should trump the moral qualms of doctors (see Bioedge, January 2, 2009).  (Here I leave aside the tendentious way in which advocates of abortion, contraception, and sterilization--where these are not medically indicated--describe these interventions as part of “reproductive health care,” although they are anti-reproductive, seldom have anything to do with the health of either mother or child, and in the case of abortion involve by definition not care but killing one of these patients.

In this discourse, the personal is contrasted with the professional, the idea being that a professional has a duty to provide whatever services are legal and demanded by clients.  The conscience of the professional is invariably given short shrift and subordinated to the supposed rights of the client to treatment.  I say “supposed” because it is not clear how the legal right to have an abortion, for example, in itself gives anyone a legal right to demand its provision, let alone legally obliging anyone else to carry it out or pay for it.  In a shift characteristic of contemporary rights discourse, a right to freedom from state interference (a “right to privacy”) is transformed into a claim on public provision (Arkes, 2002). 

Some opponents of conscience exemptions respond by saying fine, if you cannot in conscience meet the expectations and duties of the profession, leave it or choose a different line of work.  This may indeed be the only option facing conscientious individuals where no accommodation is made.  Conscience also trumps career.

Exclusion of pro-life physicians, nurses, social workers, and pharmacists from their professions and the closing down of institutions that respect life and adhere to Hippocratic ethics has practical consequences.  But my argument here against exclusion does not depend on the empirical reality that religious professionals and institutions—e.g., Catholic physicians, nurses, social workers, and pharmacists as well as hospitals and clinics—play an important role in the American health care system.  Their exclusion would involve a tremendous loss of talent, knowledge, skill, aptitude, and dedication for the healing professions.  It would also substantially reduce health care services of all kinds and therefore the access of patients to such services.  The argument here, rather, is that the coercion of conscience of professional health care and social work providers is morally corrupting for the profession concerned and its practitioners. 

Compared with simply allowing the professional participation of members in abortion, to take the clearest case, mandating such participation makes the profession even more complicit in a culture of death that betrays social work’s (as well as the medical and nursing professions’) core values.  It is a culture in which the dignity of the human person is restricted in ways that exclude precisely the most vulnerable and dependent members of society—born and unborn babies, those with severe physical and intellectual disabilities, those whose quality of life others deem inadequate. 

Justifying such an abdication of the defense of human dignity as a core social work value entails a kind of self-deception. The view that the child in the womb is not a person or a human being seems not more but less and less tenable in light of scientific advances since Roe v. Wade.  These show ever more clearly that the unborn child is a separate being with his or her own DNA and own principle of existence (George & Lee, 2005; George & Tollefsen, 2008; Lee, 2010) .  It seems a truth not easily evaded without a level of self-deception that is itself morally corrupt, that the fetus is the baby we all once were and we are alive now in part because our mothers did not have us killed at that stage of our lives (George & Tollefsen, 2008). 

In any case, if the profession as a whole accepted the evidence and logic of the position that children in the womb were as fully human as those with severe disabilities or those just born or close to death or suffering advanced dementia, but abortion remained a legal right of pregnant mothers, would NASW require its members to refuse participation, direct or indirect, in the taking of human life in any or all of these conditions? Or, on the contrary, would it still fail to defend either the most vulnerable among us or the conscience rights of its members?  Would the legal right to engage in  a gravely evil act as the profession itself now saw it be sufficient to require practitioners’ participation in the evil, whether on the grounds that client self-determination should drive professional decisionmaking or that a state license makes a practitioner an agent of the state?  This is not a far-fetched thought experiment, given the history of dehumanizing language that was and is being used to justify violent acts against vulnerable people, including not only fetal children but also African Americans, the elderly, women, and Jews (Brennan, 2000).  In particular, American liberal progressives and not just Nazis, have a long and disreputable history of objectifying and dehumanizing vulnerable persons in the name of eugenics (Largent, 2011 ;  Gallagher,1999; Sandel, 2009; Goldberg, 2008).

The Moral Agency of the Practitioner

The idea that if an action is legally permissible and demanded by a client, the social worker (or other health professional) has the duty to provide or participate in providing the requested service itself represents a fundamental shift in the balance of rights and powers between professional and client.  It strips the professional of her full moral responsibility and reduces her to a kind of machine or robot that delivers what the customer demands.  The professional’s right and duty to use her judgment about what is required or indicated or morally permissible in the situation is stripped away in favor of a kind of client “empowerment” that radically disempowers, even dehumanizes the social worker.  As the former governor of Wisconsin Jim Doyle put it when vetoing a conscience bill for health care providers, “you’re moving into very dangerous precedent where doctors make moral decisions on what medical care they provide” (Vischer, 2011).  The practitioner is reduced to a kind of vending machine, like those increasingly found in college dormitories with the function of dispensing contraceptives.

Opponents of conscience clauses and exemptions sometimes pose the matter in terms of the desire by professionals who are religious to impose their personal views or morality on clients or patients.  This is a misunderstanding.  None of the case for conscience exemptions has anything to do with imposing my will on the client.  Patients and clients have an uncontested moral right to informed consent and informed refusal.  

But this is not the issue. The client may find abortion morally permissible and it is certainly legally permissible at present in the United States.  I respect the client’s right under law to decide to have an abortion and will not condemn, moralize, or argue with her.  My right not to participate in what I believe is grave wrongdoing does not imply or depend on a right to impose my belief on the client.  “Conscientious objection, “ as Pellegrino (2008) says, “implies the physician’s right not to participate in what she thinks morally wrong, even if the patient demands it.  It does not presume the right to impose her will or conception of the good on the patient” (p.299).

The question whether someone’s right to engage in a behavior entails an obligation on anyone else’s part to assist her in the process has important implications for all professionals, but especially those supposed to be helping or healing their clients.  For any professional social worker from any faith tradition or none, such a legally mandated obligation is a serious potential threat to their conscience and as such, to their humanity as moral agents.  The issue, which applies to lawyers and physicians no less than social workers, is only in part whether a professional is obliged to treat or serve anyone who seeks her services.  Harpaz (1998), discussing the 1997 ruling of the Massachusetts Commission Against Discrimination ("MCAD") that a woman lawyer could not refuse to represent men in divorce actions under the state's public accommodation statute, shows that the issue of compelled service or representation is not simple or confined to the health and helping professions.  

For social workers, as for priests, it is common to serve clients whose behavior the practitioner finds morally repugnant.  The challenge to conscience arises not from the requirement to serve - or not to discriminate against - a particular kind of client, but from the expectation in certain cases that practitioners will act against their own judgment and collude or participate in what the practitioner determines is wrong or harmful, or simply because the client demands it.

The question is wrongly put in the form of whose conscience counts, the client’s or the professional’s.  No-one can be bound by someone else’s conscience.  The professional remains a moral agent, not a robot or vending machine, and so is responsible for following his or her own practical judgment about what is the right thing to do, all things (including the client’s wishes) considered.

Licensing and Professionalism

Another aspect of the opposition to conscience exemptions is a novel view of professional licensing.  In this view licensing, traditionally justified in terms of protecting the public by ensuring the competence of practitioners, becomes a process whereby professionals are transformed into public officials.  If the state decides to recognize same-sex marriage, then its public officials - e.g., those who issue marriage licenses - are bound to issue those licenses to whomever the state decides is now qualified under its rules.  Licensing of professionals, insofar as it transforms the practitioner into a public official obliged to do the state’s bidding, in effect becomes a process, not of safeguarding professional discretion while protecting the public, but of deprofessionalization.  Social workers, among the least secure in their professional status, are to that very extent less inclined to defend the scope and legitimacy of their own professional judgment and discretion against tendencies to subordinate them to bureaucratic-state or client demands.

There is an analogous process through which the state, by providing most of the funding of voluntary social service agencies like Catholic Charities, turns them into agents of the state.  Far from being a strength of civil society, of an institutional pluralism that protects the structures that mediate between state and individual, they become vehicles for increasing the reach of the state.  Rather than allowing for alternative visions of the common good in the associations that people with differing religious and moral commitments build over generations,  the state squeezes out the social space of civil society and becomes absolute sovereign of all. 

Conscience, Subsidiarity and the State

The coercion of Catholic consciences, then, is a threat not only to individual practitioners but also to the institutional pluralism that lies at the heart of subsidiarity and American society.  From this perspective, it is wrong to reduce matters of conscience to the state’s protection of individual rights, whether of consumer against provider, or professional against employer.  Conscience is not simply a matter of individual rights or individual autonomy vis a vis the state and civil society.  It is inherently relational.  

This case for the relational dimension of conscience, in contrast to an emphasis on individualist rights talk and the autonomous self, is persuasively made by Vischer (2010), who seeks to recapture the concept of conscience as shared knowledge.  He argues,

There is a clear need to recapture the relational dimension of conscience - the notion that the dictates of conscience are defined, articulated, and lived out in relationship with others,  Our consciences are shaped externally, our moral convictions have sources, and our sense of self comes into relief through interaction with others.  By conveying my perception of reality’s normative implications, my conscience makes truth claims that possess authority over conduct - both my own and the conduct of those who share, or come to share, my perception (p.3).

This argument has at least two important implications.  First conscience is not simply an internal oracle, with only biographical interest, like a preference in ice cream flavors.  It implies shared knowledge  and truth claims about right action.  And it binds those who share that knowledge and accept those truth claims.  

The shaping of our consciences is a matter neither of individual nor state, but of the subsidiary associational life that mediates between them, especially church and family.  These are sources of conscience formation, communities of discernment, and venues for expression.

When the state closes down avenues by which persons live out their core beliefs - and admittedly, some avenues must be closed if peaceful coexistence is to be possible - there is a cost to the continued vitality of conscience (p.4).

In this respect, Catholic social teaching offers a sharp contrast to the Hobbesian picture, in which “the sovereignty of Leviathan is absolute, so subsidiary units of the social order--churches, groups, smaller units of government--exist merely at the sufferance of the sovereign” (Moreland, 2011, p.325).

In the current attack on religious freedom and conscience, we see the relentless imposition of a new state orthodoxy and a growing intolerance of dissent on the part of subsidiary associations - even, in Canada, imposing the new sexual morality on the curricula of private religious schools and homeschooling families.

The issue of conscience, then, needs to be understood not only in terms of the rights of individuals, who must look to the state for relief or protection, but also and especially in terms of the scope for a rich associational life that subsists in tension with both individual and state.  A commitment to freedom of conscience, properly understood, “should underlie our legal system’s reluctance to restrict the independence of the myriad associations that make up the vast space between person and state” (Vischer, 2010, p.4).

From this perspective, driving Catholic organizations and professionals out of health care, education, and social services does great social harm on several levels.  Most directly, it threatens a tremendous loss of talent, knowledge, skill, aptitude, and dedication for the healing professions.  It would also substantially reduce health care services of all kinds and therefore the access of patients to such services.  In addition, the coercion of conscience of professional health care providers is morally corrupting for the profession and its practitioners.  Catholics are bound to follow their correctly formed conscience even if it means loss of job, career, profession.  Some will fail the test and be corrupted members of a profession that is corrupted by demanding such corruption - now called leaving your personal values at the door.  But a regime - like that of Antiochus IV Epiphanes - that requires such heroic sacrifice on the part of its members is also corrupt, falling as it must into what variously has been called a soft or liberal totalitarianism.

In this sense too, individual or group conscience is not at odds with the common good but constitutive of it.  The common good is not solely expressed or subsumed in the state, but requires a healthy institutional pluralism.

The HHS mandate, as Lee (2012) argues, “not only attempts to coerce Catholics to violate their conscience, it also insinuates a false redefinition of religion for our whole culture. But religion is not a creature of the state: it antedates the political community and has its structure independently of political laws and mandates.”

The Obama Administration’s narrowing of freedom of religion to freedom of worship reflects a notion of the state in direct opposition to Catholic social teaching on subidiarity.  It is a notion that, in the words of Scottish bishop Philip Tartaglia, “appears to have no respect for institutions, such as the family and the Church, which pre-exist the state, which straddle the private-public domain, and which have their own internal constitution. This is a state moving toward a kind of soft totalitarianism.”

Some Conclusions

So what is a Catholic social worker to do?

At an individual level and collectively, we have to recover the Catholic understanding of conscience as a matter of shared knowledge and truth claims, as developing moral reasoning and practical judgment in the application of general principles to particular cases.  It is about discerning the right thing to do, all things considered.  By definition, there cannot be other things to be considered in addition to conscience.  Nor can conscience be reduced to a kind of non-rational internal oracle that tells us what to do, in the manner of the voices in the head of a schizophrenic.

In this sense, conscience cannot be separated from rational argument about the right thing to do, as if it trumped or silenced such deliberation.  It is a matter of practical reasonableness.

Exemptions Not Enough

In terms of the issues at stake in current debates that divide society on matters of life, death, sex, and marriage, it may sometimes be necessary but is never sufficient to rely on conscience protections.  These issues are not matters of freedom of worship in the sense that attending Mass on Sundays is a rule that applies only to adherents of the faith.  Catholics with informed consciences object to demands that they pay for or collude in abortion, sterilization, abortifacient drugs, the normalizing of disordered sexual relations and the redefinition of marriage, assisted suicide, and so forth, not because these things are matters of right worship or religious belief that ends the temple door.  They involve truth claims about the common good and integral human development that the Church proposes - and justifies on rational grounds - to the larger society.

Without these caveats, appeals to conscience become what Barry, the New York Times, and others see them as, a call to privileged treatment and accommodation for certain beliefs just because they are strongly held or called religious.

As social workers, we are well placed to make the argument from subsidiarity - that health of a democratic pluralist society depends on maintaining the space between individual and state, for the associations, mediating structures, and natural, prepolitical institutions like marriage, family, religion, and market.  We have a tradition of empowerment that recognizes that problems are best resolved closest to the people involved and their culture and resources, that seeks to leave the caring capacity of families and communities stronger than we found it.  That tradition comports well with the arguments for subsidiarity advanced by Popes Leo XII, Pius XI and John Paul II.  In both cases there is a rejection of the Hobbesian Leviathan state that claims absolute power over the whole of society and its institutions and associations, disempowering individuals, families and communities even in the process of helping them.  Both Catholic social teaching and social work empowerment tradition, at least implicitly, reject the individualist hypertrophy of the autonomous unencumbered self no less than the hypertrophy of the state.  That space is the one in which conscience is shaped and the virtues on which it depends are developed through practice and habituation.