[CHAPTER 16][    CHAPTER 16    ]

Conscience and Social JusticeConscience and Social Justice

No provision in our Constitution ought to be dearer to man than that which protects the rights of conscience against the enterprises of the civil authority.

—Thomas Jefferson to New London Methodists, 1809

AS THE GULF HAS GROWN IN RECENT DECADES BETWEEN traditional Judeo-Christian orthodoxy and the secular state in matters of life, death, sex, and marriage, the question of conscience protections and exemptions in law has become pressing.¹ Livelihoods, careers, charitable organizations and activities, and whole communities have been put at risk in the interest of imposing measures that require many Christians and others to violate their consciences. Such coercion by the state is sometimes justified in the name of social justice.²

Unfortunately, there is as much confusion about the concept of conscience as there is about the concept of social justice. Conscience is, no less than social justice, inherently relational, rooted in community, and directed beyond the self. It is moral belief applied to conduct, conveys a claim to truth, implies accountability, restrains power, and is inseparable from personal integrity.³ Like social justice, it is key to a healthy republic and civil society, to expanding and protecting the rich associational life that occupies the social space between individual and state. Some identify with social justice, while others emphasize conscience, as if the two were in opposition. Both perspectives frame issues in terms of the rights of individuals and the role of the state, neglecting the intermediary groups and institutions of civil society. One sees the world in individualistic terms, the other collectivist, but both in relation to the state and each as opposed to the other. So it appears as if individualism stresses conscience at the expense of social justice, and collectivism does the reverse. On the contrary, rightly understood, conscience, and social justice illuminate and reinforce each other, and both are necessary to a democratic pluralist society.

The Threat to Liberty of Conscience

“Have progressives abandoned the liberty of conscience?” asks legal scholar Robert K. Vischer.⁴ Noting that the American Civil Liberties Union had filed suit to block George W. Bush’s conscience protection regulations from being implemented, and that other progressive groups that “trumpet their commitment to defending an individual’s moral integrity against government incursions were curiously silent about President Obama’s rollback” of those protections in 2011, Vischer observes:

We’ve come a long way from the times when ringing defenses of conscience were provided by progressive heroes such as Jefferson, Thoreau, and Gandhi. The former Democratic governor of Wisconsin justified his veto of a conscience bill for health care providers on the ground that “you’re moving into very dangerous precedent where doctors make moral decisions on what medical care they provide.”⁵

Among those progressive associations that have switched in recent years from defending conscience rights and protections to casually dismissing them, the National Association of Social Workers (NASW) stands in the forefront.⁶ Indeed, no other profession gives shorter 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 Christian social workers and health professionals have become ever more pressing in the United States, Canada, and Europe in recent years. A flood of writing about the subject covers everything from individual legal cases involving students, employees, and businesses across the United States to the HHS mandate and the hundred-plus lawsuits challenging it.

Here I will limit myself to developments most directly linked to social work and related practice (such as counseling) and to the threat posed to conscience by the very way in which the social-work literature frames its discussion of conscience exemptions and conscientious objection. My primary but not exclusive focus will be on threats to liberty of conscience of individual practitioners rather than, as in the case of the HHS mandate, their employers. I want to suggest that the usual way of framing conscience issues in current debates, as matters of individual rights enforced or limited by the state, is inadequate, and I mean to propose a more complex but far from new way to think about the options and ethical obligations of professionals in contested areas, where expanding state coercion of conscience conflicts most sharply with moral conviction or religious faith.

Threats

Christians, Jews, and others in social work and related fields who adhere to the Judeo-Christian tradition in matters of life, death, sex, and marriage face threats to conscience at every level. As Robert George argues,⁷ the secular-liberal orthodoxy in these areas aims not to foster tolerance of religious orthodoxy or pluralism, but to build a monopoly in the public square.

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 January 2012, the U.S. Court of Appeals of the Sixth Circuit⁸ ruled in Ward’s favor, and 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,⁹ legitimated by a constrictive and unwarranted 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 beliefs contrary to their own convictions, 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 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 have become rights, expanding the options for those who wish to engage in these behaviors. But what is optional behavior for clients or patients rapidly becomes mandatory for professionals who must endorse or otherwise cooperate in the newly permitted behavior. An argument for tolerating certain behaviors has become a case for intolerance—of those who refuse to be personally or professionally complicit in them.¹⁰

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.”¹¹ The legally binding UN 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.¹²

With astonishing speed, legal protections of children before birth have been swept away in both letter and spirit. UN officials have been attempting to pressure sovereign member states to establish abortion as a legal right.¹³

Far from resisting these threats, professional associations have revised the Hippocratic and other oaths to eliminate the prohibitions on killing—whether through abortion, euthanasia, or assisted suicide. Professional ethics codes once forbidding abortion and other life-terminating measures now come close to making direct or indirect participation in them a requirement of professional practice.¹⁴

In recent years, the threat to conscience rights has widened beyond abortion and the duties and rights of physicians, nurses, and pharmacists to areas in which social workers are more directly and routinely involved. Among these are counseling, psychotherapy, foster care, and adoption, where practitioners and agencies are expected to affirm same-sex sexual relations and, across the United 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, Helen Alvaré argues,¹⁵ 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, “the government is promoting sexualityism—a commitment to uncommitted, unencumbered, inconsequential sex.”

The HHS mandate stands on this theory. In a world of easily available birth control and abortion, the only reason for a federal mandate for a “free” and universal supply is 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?¹⁶

The HHS mandate requiring all employers, with narrow exceptions, to provide “insurance” coverage for abortifacients, contraceptives, and sterilization threatens the religious freedom of all Catholic and many other Christian employers.

In cases such as a small town built around a Catholic or Evangelical university that refuses, on grounds of conscience, to comply with the mandate, the very existence of the whole community is in jeopardy due to the fines imposed for noncompliance. This modern variant of Saint Benedict’s solution—building centers of Christian fidelity, learning, and devotion, tilling and keeping our own garden in the face of a culture of barbarism outside—would be foreclosed. Such communities face something more analogous to Henry VIII’s dissolution of English monasteries in the 1530s.

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 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.”¹⁷

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. Again, these considerations apply also to other adherents of Judeo-Christian orthodoxy (in the broad sense distinguished by Robert George from the state-imposed secular-liberal orthodoxy¹⁸).

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 J. Sweifach’s study¹⁹ 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 these 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 recognizes an individual pharmacist’s right to conscientious refusal.²⁰ The AMA’s 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.”²¹ According to the American Nurses Association,²² 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.²³

In social work, by 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 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.”²⁴ 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 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 beyond being the subjective opinions of those who hold them. If this is so, then why should the personal opinions of a practitioner not be subordinated to those of the state that licenses and funds his or her professional work?

Much social-work literature on the subject frames issues of conscience in this way, as a conflict between personal and professional values. Sweifach gives several examples framing the issue of conscience and conscientious objection in those terms.²⁵ For instance, N. Linzer 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.”²⁶ According to this view, it is ethical, in these circumstances, to act against your own conscience.

As Christian social workers come under increasing pressure to cooperate with what they consider evil, in the name of professional duty, the question of conscience becomes correspondingly more urgent. Statements from NASW, its executive director,²⁷ and its Legal Defense Fund²⁸ make it clear that their professional organization will not defend the conscience rights of 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 putting your immortal soul in jeopardy; for a Catholic Christian, it means excommunicating yourself from your Church and its sacraments.

In its hotly disputed Opinion #385, “The Limits of Conscientious Refusal in Reproductive Medicine,” the Committee on Ethics of the American College of Obstetricians and Gynecologists takes the position that prolife physicians must refer patients seeking an abortion to other providers, must tell patients in advance of their views without explaining or arguing for them, and must, in emergency cases involving the patient’s physical or mental health, actually perform abortions. It treats conscience as but one value among others that can and should be overridden in the interest of other obligations. 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, implicit in 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. 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. Here “all things” 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.”²⁹ Conceptualized as a faculty of the individual, conscience too readily becomes detached from judgments of practical reason about the right thing to do. Herbert McCabe 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.”³⁰

Conscience in this view is not subjective opinion 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.”³¹ For Aquinas and the Catholic 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 and correct autonomous inner voice, but because it is, all things considered, our best practical judgment of right action. It is a necessary but not sufficient condition of acting well. As Elizabeth Anscombe puts it in her justly renowned critique of “Modern Moral Philosophy,” “a man’s conscience may tell him to do the vilest things.”³²

Karl Jaspers gave the example of a young German concentration-camp guard he met in a hospital at the end of World War II—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.³³ 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. Anscombe—in unpublished notes for a lecture—argues the dilemma thus:

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, 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.³⁴

We do wrong both when we act against our conscience and when we follow a badly formed conscience into evil actions or failures to act, 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, John Paul II writes in Veritatis Splendor (1993), 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, nonrational inner guide or faculty, it appears reasonable to reject its claims in policy and law, even when a religious motivation is claimed. The logic is expressed, for example, by the late political philosopher Brian Barry, for whom conscientious objections based on religious belief are simply preferences.³⁵ Barry asks why some, namely religious, preferences should be privileged in law or policy over others. Why should the state bend over backward to accommodate the preferences of a minority? Why should laws be crafted so that no one will ever be unnecessarily coerced into violating conscience?

Melissa Moschella summarizes the argument 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?³⁶

No one claims that the conscience of a given individual or group always trumps other considerations in policy making. 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 adherents 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. As Moschella argues:

There 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.³⁷

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 to have my sons circumcised and the state’s compelling me to do or not to do so.

As Moschella 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.”³⁸ Such laws distribute the burdens and social benefits of social cooperation unequally. A difference in kind of burden is imposed, not merely one 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 prohibited them from performing circumcisions. Those who refused to violate their consciences in this way “were to be broken on the wheel and killed.”³⁹ 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 Michael Stokes Paulsen 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.”⁴⁰ Like the HHS mandate, it was an unnecessary 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

With the HHS mandate, the Obama administration reduces religious freedom to freedom of worship. The mandate promotes a false but prevalent idea of religion as a private and marginal activity, the practice of which involves only coreligionists. 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 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 Christian and non-Christian—is not an optional add-on to the free exercise of religious faith. These duties have been a corporate responsibility of the Church, not just of individual members, from the very beginnings.

Conscience, Professional Duty, and Moral Agency

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.

The client’s right to a full range of services may depend on 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.⁴¹

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 right of the client to treatment.⁴² 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.⁴³

One response to the conflict between conscience and the newly defined duties supported by the new moral orthodoxy is to say, “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.

The exclusion from their professions of physicians, nurses, social workers, and pharmacists who adhere to the traditional Judeo-Christian religious orthodoxy and the closing down of institutions that respect life and adhere to Hippocratic ethics have practical consequences. But my argument here against exclusion does not depend on the empirical reality that religious professionals and institutions—for example, Catholic and other Christian 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, child welfare, and social services of all kinds and therefore the access of patients and clients to such services. The point, rather, is that the coercion of conscience of professional health-care and social-work providers is morally corrupting for the professions and their practitioners and damaging to civil society.

There is a sharp difference between allowing and requiring professional participation in certain services or treatments. Requiring participation pressures some professionals into morally degrading choices to act on beliefs contrary to those they hold, as a condition of entering or remaining in their chosen profession. To require violation of conscience in this way corrupts the profession and those who submit to such requirements. A regrettable irony is that the moral integrity of persons, and so of associations and their members, is itself constitutive of “human and community well-being,”⁴⁴ which social work and the other helping professions claim is their purpose to promote.

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 to deliver what the customer demands. The professional’s right and duty to use her judgment about what is required or indicated or morally permissible is nullified. A new form of client “empowerment” thus radically disempowers, even dehumanizes, the professional.

Opponents of conscience clauses and exemptions sometimes frame the matter in terms of religious professionals’ desire to impose their personal views or morality on clients or patients. This is a misunderstanding. The case for conscience exemptions has nothing to do with imposing my will on the client.

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. But this is not the issue at stake with respect to conscience exemptions.

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,” Edmund Pellegrino writes, “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.”⁴⁵

The question of 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. In many cases, such legally mandated obligations pose serious threats to conscience and, as such, to professionals’ humanity as moral agents. The issue, which applies to lawyers and physicians no less than to social workers, is only in part whether a professional is obliged to serve anyone who seeks her services. Leora Harpaz, discussing the 1997 ruling of the Massachusetts Commission Against Discrimination 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 is not simple or confined to the health and helping professions.⁴⁶

For social workers and many other professionals, as for priests, it is common to serve clients whose behavior they find 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, simply because the client demands it.

Whose conscience counts, the client’s or the professional’s? This is the wrong question. 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 the right thing to do, all things (including the client’s wishes) considered.

Licensing and Professionalism

A novel view of professional licensing also emerges to support opposition to conscience exemptions, one that further narrows the scope of civil society, the social space between individual and state. In this view, licensing, traditionally justified as protecting the public by ensuring the competence of practitioners, becomes a process whereby professionals are transformed into public officials. And when they become public officials, they become legally bound to act in certain ways, regardless of personal conscience. If the state decides to recognize same-sex marriage, for example, then its public officials who issue marriage licenses are legally bound to issue those licenses to whomever the state decides is now qualified under its rules. Period.

So licensing of professionals, insofar as it transforms the practitioner into a public official obliged to do the state’s bidding, has the effect not of safeguarding professional discretion while protecting the public, but of deprofessionalization. Social workers, precisely because they are among the least secure in their professional status, are 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.

Analogously, by providing most of the funding of voluntary social-service agencies like Catholic Charities, the state turns these into its own agents. Far from being a strength of civil society which guards the space between state and individual, such agencies 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 have built over generations, the state weakens civil society and becomes absolute sovereign of all.

Conscience, Subsidiarity, and the State

The coercion of Christian consciences is a threat not only to individual practitioners but also to the institutional pluralism that lies at the heart of subsidiarity, social justice, and American democracy. 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-à-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 on the autonomous self, is persuasively made by Robert Vischer, 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.⁴⁷

This argument has at least two important implications. First, conscience is not simply an internal oracle 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.

Second, shaping our consciences is a matter of neither the individual nor the 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. In Vischer’s words: “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.”⁴⁸

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.”⁴⁹

Attacks on religious freedom and conscience relentlessly seek to impose a new orthodoxy and an attendant intolerance of dissent from 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.”⁵⁰

Driving Christian 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 these professions. It would also substantially reduce health care and social services of all kinds, and therefore the access of patients and clients to such services. In addition, coercing the consciences of professionals is morally corrupting for both individuals and their professions. Christians are bound to follow their correctly formed conscience, even if it means loss of livelihood. Some will fail the test, however, in the name of what is now called leaving your personal values at the door. But a regime that requires such heroic sacrifice of its members—like that of Antiochus IV Epiphanes—is also corrupt, falling into what has been called a soft or liberal totalitarianism.

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.

Some Conclusions

One kind of choice in social-welfare policy is often reduced to a dichotomy between individualism and collectivism. This reduction not only artificially narrows the range of possible policy options⁵¹ but also misses the ways in which these ideologies in practice reinforce and depend on each other precisely by hollowing out the space between individual and state.

Pius XI made the same point in a surprising context, the publication of his social encyclical Quadragesimo Anno (1931), at a time when Communist, Fascist, and National Socialist totalitarianism were ascendant. Startlingly, Pius blames individualism for pushing the state in this direction:

When we speak of the reform of institutions, the State comes chiefly to mind, not as if universal well-being were to be expected from its activity, but because things have come to such a pass through the evil of what we have termed “individualism” that, following upon the overthrow and near extinction of that rich social life which was once highly developed through associations of various kinds, there remain virtually only individuals and the State. This is to the great harm of the State itself; for, with a structure of social governance lost, and with the taking over of all the burdens which the wrecked associations once bore, the State has been overwhelmed and crushed by almost infinite tasks and duties.⁵²

Both Catholic social teaching and the social-work empowerment tradition reject the individualist hypertrophy of the autonomous unencumbered self no less than the hypertrophy of the state. The space—of civil society or mediating structures—between individual and state is the one in which conscience is shaped and the virtues on which it depends are developed through practice and habituation. The virtue of social justice also requires and develops that space in which citizens join together in pursuit of the common good.