An issue nurses can’t avoid


I am sure each of us has our own opinion about insurance coverage for contraception and abortion. And as health professionals, many of us undoubtedly will be dealing on several levels with patients and the public on this issue. So perhaps, a reprise of the basic issue is in order.

On New Year’s Day, 1802, Thomas Jefferson wrote the famous letter in which he penned what has become iconic in American’s understanding of the relationship between government and
religion Here’s part of it:

Believing with you that religion is a matter which lies solely between Man & his God, that he owes account to none other for his faith or his worship, that the legitimate powers of government reach actions only, & not opinions, I contemplate with sovereign reverence that act of the whole American people which declared that their legislature should “make no law respecting an establishment of religion, or prohibiting the free exercise thereof,” thus building a wall of separation between Church & State.

On January 20, 2012, the Obama administration’s narrow ruling on the Affordable Care Act’s contraception mandate would have required Catholic charities, schools, and hospitals to facilitate something contrary to faith. The number of Catholic women who have used and continue to use contraception is irrelevant to the fundamental issue of the separation of church and state.

However, a few weeks later, it seems the Obama Administration agreed with critics of this ruling, who believe it intruded on the religious freedom of Catholic institutions. So on February 10,the administration shifted the mandated contraception coverage from religious institutions to insurance companies. Now, however, the U.S. Council of Catholic Bishops and antiabortionists in general are demanding not just exemptions from the contraception mandate for religious institutions but total elimination of the contraception mandate for health insurance generally. This transforms the issue from one of religious liberty for church institutions to one of contraception itself.

It’s worth remembering that Jefferson understood his “wall of separation” to protect churches and church institutions against government intrusion into their internal practices. But it also was meant to protect the people from imposition of any one religion on all of them. Religion and adherence to religious beliefs is a free choice in our country. For a religious institution, no matter how large, to insist that a pluralistic society adhere to its religious teachings is a violation of freedom for those of other religions—or of religion at all. Jefferson’s wall separates church and state, not insurance company and state.


The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.


  • Leah, You have eloquently “spoken” the message I believe is true to America. Thank you. Each is free to believe and each is to be free from others’ beliefs.

  • Every nurse has the freedom to choose where they work or don’t work. If one is strongly antiabortion, one should choose a job that will not cause a “conscience” issue. The bottom line here is every woman’s right to make the choice for herself among medications/procedures which are legal. Thomas Jefferson could not have anticipated any of this discussion because there was no such thing as insurance OR woman’s contraception.

  • So, nurses’ freedom of conscience is protected, but Church-run institutions are not?

  • There is a conscience clause provision that has been upheld by the Courts. Health personnel need not participate in abortion — and religious institutions don’t have to offer them. This was confirmed in federal court decades ago!

  • The insurance sidestep does not address all the issues, including being forced as a nurse to participate in a procedure or for the institution to provide it. Freedom of conscience, and the DIS-establishment of religion, is still a question. This is not a tax decision, so the question of constitutionality remains.

  • Our tax dollars are spent on many things various Americans do not agree with — and their expenditure cannot be determined by individual taxpayers or there would be chaos:pacifists wouldn’t pay if taxes are used to support the military; anti-abortionists won’t pay if tax dollars cover abortion; vegans won’t pay if taxes cover the use of any animal products; etcetera and so on. Our taxes are the ‘rent’ we pay for living in the USA — and their expenditure is determined by those we elect to do so

  • “between”, not “being”. Sorry.

  • Government has no business telling a women what she can or cannot do with her body. That decision is being the person and her god. That is why there should be no such thing as governmental insurance, nor should the government try NOT to cover something that is legal.

  • Hormonal meds, like it or not, are legal and legitimate drugs for many conditions other than contraception. And, like it or not, the termination of a pregnancy is a legal medical procedure. If you’re against it, don’t have one and don’t, as an RN, participate in the surgery. Caving to the Bishops opens the door to imposition of sharia law by the next religious org that doesn’t like separation of church and state.

  • I wonder how Jefferson would have felt about the government paying for contraception and abortion? I think he would have tried to prevent that from happening. In essence, an antiabortionist’s tax dollars are paying for what he thinks abhorent.

  • It would be a crime against all women if the government backs down to the Bishops and refuses coverage of birth control services for all women!

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