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Freedom of Conscience and Health Care in the United States of America: The Conflict Between Public Health and Religious Liberty in the Patient Protection and Affordable Care Act

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Abstract

The recent confirmation of the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties.

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Notes

  1. Participation in public health care can be viewed in this context as either financial or medical. To participate financially is to contribute to the cost of treatment or prevention of disease, while medical participation occurs when agents use preventative medical services such as vaccination.

  2. See for example, Paul Farmer’s discussion of the cost of tuberculosis control in New York City between 1968 and 1992 where reductions in public spending for TB control and treatment was cut dramatically, leading to vastly increased costs, and increased health risks in later years [11].

  3. Thomson’s seminal paper on reproductive autonomy should be familiar to many, and is just as relevant now when analysing criticisms of the PPACA as it was when it was first published [34].

  4. See [18] for a discussion of solidarity related arguments for participation in vaccination programmes.

  5. In the legal case mentioned above, part of the Court’s justification for refusing the plaintiff’s claim for exemption was that they did regularly pay taxes for other social welfare programmes such as Medicare and social security which present the same conflict with their stated beliefs as the purchase of health insurance under the PPACA [36].

Abbreviations

MDRTB:

Multi-drug resistant tuberculosis

NHS:

National Health Service

PEPFAR:

President’s Emergency Plan for AIDS Relief

PPACA:

Patient Protection and Affordable Care Act

STI:

Sexually transmitted infection

XDRTB:

Extremely drug resistant tuberculosis

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Acknowledgments

I would like to thank the Arts and Humanities Research Council for their ongoing funding of my graduate research and the participants of the ‘Think About Health’ Network conference in April 2012 for their comments on preliminary research for this paper. Parts of this paper were developed from ideas first presented at the Political Studies Association Annual Conference in Belfast 2012.

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  1. Department of Philosophy, The University of Birmingham, ERI Building Edgbaston, Birmingham, B15 2TT, UK

    Peter West-Oram

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West-Oram, P. Freedom of Conscience and Health Care in the United States of America: The Conflict Between Public Health and Religious Liberty in the Patient Protection and Affordable Care Act. Health Care Anal 21, 237–247 (2013). https://doi.org/10.1007/s10728-013-0251-6

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