Sunday, May 26, 2013

The Ethics of Exemptions

If you’ve been following the ongoing efforts to water down or otherwise weaken the Healthcare Reform Act – since the 37 attempts by Republicans in Congress to repeal the act outright have all failed – you’ve probably noticed the exemption offered for religious organizations regarding contraception. The argument goes that since some religious groups oppose birth control in any form, forcing them to pay for these services for their employees would be a violation of their First Amendment right to Freedom of Religion. This is usually countered with arguments that the organizations themselves aren’t paying for birth control – their insurance providers are, which leads to discussions about self-insuring agencies, final responsibility, and claims (and usually counter-claims) about conflicts of interest. But as upsetting as all of these disputes are, they still fail to take into account one of the obvious consequences of allowing any exemptions to our national healthcare laws in the first place…

If you allow any exemptions to any law, somebody will eventually attempt to use that exemption to their own benefit, regardless of whether or not the exemption is actually appropriate. This is the origin of cases where someone who isn’t a Native American has their house declared Tribal land and starts a casino, people whose official residence is somewhere off-shore to avoid paying taxes, and billionaires who receive Federal farm assistance money every year because they own just enough agricultural property to qualify. In a setting like this you’d have to be an idiot not to expect anyone who can do so to try to game the system; the real question becomes at what point is the requested exemption a reasonable interpretation of the law, and at what point does it become fraud?

Consider the case brought by the Hobby Lobby organization in Federal Appeals Court this past week to avoid having to pay for contraception services for their employees on the grounds that it would violate the company’s religious beliefs. The company points out that they use proceeds from their for-profit business to support the efforts of their ministry, and that therefore the entire organization can be seen as the support system for a religious enterprise. The claim may seem absurd on the face of it, especially since the company itself isn’t registered as a religious organization, and therefore has no legal requirement to spend any amount of funds any specific activity. But that’s exactly the problem: if we are going to allow exemptions for churches, then can we deny them to religious schools? If we allow them for religious schools, can we deny them to religious hospitals? How far from the actual house of worship can we extend this type of religion-based exemption before the whole question becomes absurd?

Even worse is the fact that while Hobby Lobby may appear to be gaming the letter of the law, there is at least some possibility that they are keeping to the spirit. Consider, for example, a company that really is run according to Christian ethics – providing people with money and other support on the basis of need, rather than the amount of work received in return, and so on. This could still be a for-profit company – it could still make a profit each year, in fact – but it would have a real chance of reaching people who would never go to church, let alone listen to a sermon once they got there. Such an enterprise could, at least in theory, adhere more closely to the central beliefs of that faith than any conventional religious institution. If it does so, how can we dismiss it as merely another business enterprise, undeserving of any special consideration?

Which leads me to the question: Can we allow any organization to have exemptions from a law that promotes the general health and welfare of the entire population on the grounds of maintaining religious freedom to the people involved with that organization? Can we allow any such exemptions, in fact, knowing that a non-zero number of applications will be made by people and organizations who have no reasonable justification for requesting them? Does freedom of religion override the right of all people to have complete medical care? And if it can only be said to do so in specific cases and for specific organizations, where do we draw those lines, and who gets to draw it? Or should we just have one set of rules for every organization and company and let the fallout (holy or otherwise) fall where it may?

It’s worth thinking about…

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