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The Pill, the Pox and the Limits of Religious Freedom

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300 million dead worldwide from smallpox in the 20th century alone.  No wonder the United States Public Health Service is run by a General—fighting infectious disease was a life or death battle back then, and countries that failed to mobilize against the enemy would leave millions dead on the battlefield.

In Germany, as I discussed in a recent post, the urgency of fighting infections led to mandatory vaccination laws in the late 1800s.  In the U.S., it led to aggressive vaccination programs, but efforts to make such programs mandatory inevitably ran up against unique American barriers.

Like religious freedom.

During the 1890s, according to historian Michael Willrich in his excellent book Pox: An American History, Christian Scientists denounced compulsory vaccination as not only a violation of God’s laws, but also as an encroachment of their religious freedom.  Church leaders even took the government to court, winning a landmark case in Beloit, Wisconsin giving a family the right to send their unvaccinated child to school.

But Christian Scientists did not have an undefeated record in the courts.  When smallpox ravaged the town of Americas, Georgia in 1899, for instance, Christian Scientists who refused vaccines were thrown in jail.

Interesting to consider those smallpox vaccine battles in light of the current controversy  over whether employers need to offer health insurance that covers the cost of birth control.  For those who have not been following this controversy closely, it has so far played out something like this:

  • (1)          Obama administration requires health insurers to cover birth control
    • (1a)        Exception made for religious organizations, like churches
    • (1b)        No exception for church run, non-religious organizations, such as Catholic universities
  • (2)          Catholic leaders, among others, freak out
    • (2a)        Say that the mandate violates their religious freedom
  • (3)          Obama administration tries to compromise
    • (3a)        Employers don’t have to pay for birth control coverage
    • (3b)        Health insurers can do that
    • (3c)        It will save insurers money anyway
  • (4)          Catholic leaders still irate
    • (4a)        If the bishops weren’t already voting Republican because of abortion politics
    • (4b)        They’d be voting Republican now!
  • (5)          Controversy extends to non-religious organizations
    • (5a)        Catholic business owner wins early legal case
    • (5b)        Religious freedom means not having to follow law?

The battle over birth control pills is far over.  Expect many legal cases testing the boundaries of the birth control mandate over the next couple years, with the possibility that the mandate will be thrown out completely.

What does our smallpox history teach us about this new controversy?

The lessons are limited because birth control pills, for all their benefits, don’t compare to smallpox vaccines.  The smallpox vaccine literally was the difference between life and death back in the early 1900s.  The vaccine differs from birth control pills not only in the size of its benefit to recipients, but also because the vaccine benefits more than simply the person who receives it.  When one person gets vaccinated, the population at large benefits, because that vaccine thereby reduces the infectivity of the virus.

Despite differences between the smallpox vaccine and birth control pills, the battle between Christian Scientists over vaccine mandates is still instructive for today’s controversy.  You see, leaders of the Christian Science movement realized that if they continue to resist vaccines, their very religion is at stake.  They needed state recognition of their movement as a religion.  They also needed to avoid being run out of town for their beliefs.  (Utah, after all, was already taken.)  So Mary Baker Eddy, founder of the church, appealed to her followers: “If the law demand an individual to submit to this process, he obey the law; and then appeal to the gospel to save him from any bad results.”  Although many individual Christian Scientists found ways of avoiding the vaccine, their church more generally fell in line.  Religious freedom could not compete with the threat of a widening smallpox epidemic.

What about today’s controversy?  There is no epidemic threatening us enough to warrant major new limits on religious liberty.  But consider that Catholic business owner fighting not to offer health insurance that covers birth control pills: suppose the public agrees that it is in his right to deny this to his female employees.  Would we feel the same way about, say, a successful Christian Scientist CEO who decides not to offer any health insurance to his employees?  After all, health insurance violates some Christian Scientist’s beliefs just as much as birth control pills violate that Catholic owner’s beliefs?  If we really think that the health insurance that employers offer to their employees ought to vary depending on the employer’s religious beliefs, then we need to take this view to its logical extreme.  We should be fine with a Christian Scientist refusing any health insurance coverage for his employees  And with Scientology bakery owners denying mental health coverage to their employees.

I don’t like this idea.  As a physician, I am biased in favor of providing basic health insurance coverage to people.  Individual employees should still have the freedom to, for example, not use birth control pills if that violates their Catholic beliefs, to refuse blood transfusions if that violates their beliefs as Jehovah’s Witnesses, or to refuse all healthcare if that violates their Christian Scientist beliefs.  Indeed, the Christian Science Church provides a standard health insurance plan for all its employees.  The Church recognizes that individuals should have freedom to make this choice, and that employers should not unnecessarily restrict their options.

Religious freedom should be first and foremost a protection of each individual’s right to believe what she wants to believe, to pray to whatever god she chooses to pray to, and even to believe in no god without fear of state intervention.  And it should allow adults to refuse medical interventions that they don’t want to receive.

But religious freedom should not mean giving power to business owners to prevent their employees from having access to basic healthcare coverage.