bioethics, pop culture

Burwell v. Hobby Lobby: What’s it all about?

Recently, the Supreme Court ruled in a 5-4 ruling that Hobby Lobby, a corporation owned and operated by a faithful Christian family, does not have to follow all the contraceptive mandates of the Affordable Healthcare Act. The controversial case known as Burwell v. Hobby Lobby has many people up in arms, angry that a bunch of old men decided the reproductive rights of women, and concerned that other places will be following suit.

Just check out a couple articles on the matter here from the New York Timeshere from the Boston Globehere from MSNBC, and even here from Buzzfeed.

Let’s all take a collective deep breath. Remember, the earth is still spinning. You’re still breathing and obviously mentating if you’re reading this sentence. The world is not ending, and the world is still full of media bias. Regardless of how this case got spun, let’s look at the case itself.

In a controversial part of the Affordable Healthcare Act (ACA), the bill mandates that nearly all employers must provide insurance that covers contraceptives at no cost to the employee. Before the ACA, women purchased contraceptives out of pocket or paid a co-pay.

I pay for toothpaste. It’s a wonderful mechanism designed to prevent cavities and promote oral health. Is paying for my toothpaste an infringement on my “oral health rights?” Is paying for my toothpaste “a war on teeth?” No. That is absurd.

This is my logic when it comes to paying for contraceptives. For a while, I was on the pill for its hormonal properties. It was pre-ACA, so I paid a co-pay. Life went on.

Is paying for contraceptives an infringement on “reproductive rights” or inherently a “war on women?” I think not. I think those terms would be appropriate if all of a sudden, contraceptives weren’t available. But they are. Oh, they are. I have health care providers try to stuff some contraceptive measure down my throat whenever I get checked up because I’m not on pill or device to prevent pregnancy.

If anything, I think the government subtly telling women that their natural fertility is abnormal and must be fixed by medications is a war on women. I think health care providers writing prescriptions for a Group 1 WHO carcinogen (estrogen) so easily is dangerous. I think information on infertility after contraception is lacking. I think all this talk of contraception diminishes the pain of women who cannot conceive or who have suffered a miscarriage. I think focus on contraception as the be all end all also makes women who use contraception and find themselves pregnant frustrated and confused.

Can I also mention that other medications essential for women’s health aren’t provided at no cost? Like heart medications? Like diabetes medications? Like medications that can literally save their lives? Those are all dependent on your insurance plan. From experience, I can tell you that some women still need to pick between food and medications, even post-ACA.

Now, contraceptives as a medication. Yes, they can also be used for their hormonal properties. I’ve used the pill for that, and many women do. But the pill is a Band-Aid. As soon as you want to have kids or whatever reason you stop taking it, all those problems are still there. Have endometriosis? Yup, you still have it when you’re on or off the pill. Have PCOS? Yup, you still have it when you’re on or off the pill. Just now, you have one less treatment option off the pill when you’re trying to have kids.

Thing is, hormones don’t just influence your fertility. They influence your brain and who you’re attracted to (yes, there’s studies on this). They influence the way your blood clots (thus the risk of pulmonary embolisms and deep vein thrombosis). And that’s just two things off the top of my head.

I met a patient my age who suffered permanent liver damage from blood clots from the pill. I had a roommate who had blood clots from the pill. I just heard a story the other day who a woman with an IUD had her uterus punctured and almost bled to death. One of the first things she was told in recovery was that she was still a good candidate for an IUD. You know, the thing that almost just killed her and had to be surgically removed.

These dangerous side effects happen, and it’s a small voice in the overall dialogue on birth control. But, let’s just look at fertility itself for a second. Women do not get pregnant on their own. Fertility is also a men’s issue.

Women are only fertile for a small period of time. Men are always fertile.

Where’s the law on men’s contraceptives and condoms if we’re going to complain about a “war on women?” Also, if we’re going to cover sterilizations, why aren’t vasectomies covered at the moment? Vasectomies can be done outpatient. I’ve seen women after their “tubes are tied” aka a tubal ligation. They’re writhing in pain. The men? Not as much. Vasectomies can be done outpatient or even in a doctor’s office and are typically less painful.

So, how is covering women’s sterilization and not men’s a war on women? Where’s the complaints on men’s reproductive rights? You’re making a painful procedure for women freeand make men pay to have a less painful procedure.

Oh, and only condoms really help prevent sexually transmitted diseases and infections. Yet, those aren’t covered. Instead, sexually transmitted disease and infection counseling is provided. Yet we don’t cover the thing that helps prevent them.

As a health care provider (a nurse), I do not support a majority of the contraceptives on the market or how easy they are prescribed to women. Like all medications and procedures, these have risks. For me, it took a 5-second complaint about cramps and acne to be put on the pill. I wasn’t told any risks. I wasn’t really told anything. I was given a drug that could put me at risk for death via blood clots easily, probably because I was almost 18, about to go to college, and though I wasn’t sexually active, for all everyone knew, I was about to be.

Fertility is natural, and I do not think it is the duty or right of medicine to routinely mess with natural processes that are inherently beneficial.

We’re all a product of fertility. That’s a beneficial, good thing. Sure, they say the world’s going down the tubes, but I think the fact that we’re alive is pretty great. I personally like breathing and living. It’s pretty awesome.

As a Catholic Christian, I admit, I do struggle with the stance on birth control.  As I’ve mentioned, I was on the pill myself for a while. It took years for me to even be open to the idea that I didn’t need to prevent my natural fertility. I guess I was mostly afraid that I’d be unhappy off birth control. As with most fears, it proved false. I am quite happy with my scientifically-studied natural family planning method of fertility awareness (which, in itself, is another tangent).

But Burwell v. Hobby Lobby wasn’t about every single contraceptive. 24 are covered under ACA. Hobby Lobby disputed 4. FOUR. These 4 are what the company considers abortifacients – two IUDs (intrauterine devices) and two morning-after-pills.

Now, some places and educated people on the internet have written that these two things are not abortifacients since they supposedly do not cause an abortion. An abortifacient is defined as “that which will cause a miscarriage” aka end a pregnancy. Do you want to know what the scientific term is for miscarriage? Spontaneous abortion.

So, how is it that a drug intended to end a pregnancy is not an abortifacient? When the term for miscarriage is scientifically called a spontaneous abortion? And these drugs induce a miscarriage by either preventing a fertilized egg (a zygote) from implanting or scraping it away from the uterine wall?

Yeah, explain that to me again in scientific fact and terminology, please. Let us not forget science in the face of political debate about birth control, abortions, and “reproductive rights.” Science is meant to be objective, so let’s review the objective facts about life.

An organism must have six things in order to be considered alive: a cellular structure, the ability to find and use energy, growth and development, reproduction, response to surroundings, and adaption.

As soon as an ovum (egg) and sperm unite to form a zygote, this one cell has all the characteristics of life. This is so important, it bears repeating and italics. A zygote is an alive, independent organism by all scientific definitions. If we found a zygote on Mars or the moon or whatever distant planet, we would say we found life.

So how is the definition of life different inside a woman’s uterus if the life is not planned or wanted?

Simply, it is not different. The definition of life has not changed.

Our bodies have bacteria in them that is different from us that we didn’t plan or necessarily want in there, but we let them live. In fact, certain bacteria help us live, but this isn’t the time to delve into the health benefits of probiotics.

Abortion is a truly personhood debate. Science knows when life begins and what is means to be alive. New human life begins at conception. When personhood begins is up to an individual.

I would argue that a lot of us treat each other as less then a person on a regular basis. A lot of us (myself included) can treat each other like crap. When we treat another person like crap, we deny his or her personhood by our actions. In the same way that we deny a zygote has personhood, we can deny that fully developed humans beings have personhood (and therefore deserve the full dignity and respect of personhood) because they’re not useful enough to society or whatever rationalization we use in our heads.

Now, I realize abortion is not easy nor an easy topic to discuss in a few, pointed paragraphs probably laced with more sarcasm and frustation than intended. Unplanned pregnancy cannot be an easy situation. With all my heart, I hope any woman facing a circumstance where she is considering abortion finds the support she needs. I shudder when my Christian brothers and sister speak so harshly of women who have considered or even had an abortion. At the center of any discussion on abortion, we need to keep in mind the women, the very human persons who are so distraught at their circumstances that they consider or feel they must end the life of their child. These women deserve our compassion, not contempt.

Children and birthing process scares me. I cannot say I would not consider abortion if I all of a sudden became pregnant today. It would be tempting. Children are a lot of work. But I also see the joy and happiness that’s entered my family since my nephew was born. Children can’t be all bad and no joy.

I know not everyone has this view, and I respect that. Really, I do. And I understand not every woman wants children. That’s fine. I respect that.

But, as Burwell v. Hobby Lobby decided, my deeply held religious view needs to be respected as well.

Since the beginning of the ACA mandate to cover contraceptives, they made an exemption. The exemption basically applied to churches, as in the physical building of the church and its employees. They scaled back the exemption in 2012, and they may have to again after this ruling.

The Burwell v. Hobby Lobby case is the law defending that the church extends beyond the building of the church, even into a corporation and a place of work.

The church is not the building. The building doesn’t matter. Since the beginning, it’s the members that make the church. Early Christians met in caves and homes because they couldn’t build churches. Even today, it’s you and I in church, in the community, at work, and everywhere. You and I: that is the church.

As a Christian, Jew, Muslim, whatever your faith, we are asked to be consistent in our faith in any circumstance. To ask a man or woman of business to abandon his or her faith at work is unfair and unethical. Faith is what makes me work harder, practice honestly, and speak kindly. Asking me to turn off my faith is asking me to bury the best parts of myself.

Today, I think we’re tempted to put God in a box that we only open on Sundays (or Saturdays or whatever day) when we’re in a church or holy place. We don’t want God in our communities, our workplace, or even our bedrooms. Why? I suspect we’re afraid He’s judging us because we see what we’re doing too and are judging ourselves. At least, that’s why I was afraid.

It’s understandable, for sure. I know I put God in a box for years upon years because I wanted to control my life. I picked and chose parts of my faith that were convenient for me because I wanted my life to be easy. I equated a holy life to an easy life.

God doesn’t live in a box. Holy people like the Dalai Lama, Mother Teresa, Gandhi live and lived extraordinary difficult lives. Faith or no faith, religion or no religion, life is going to have its hard moments. It’s not a matter of if bad things happen but when. As a nurse, I see people’s bad moments every day I work. Trust me, it’s a matter of when.

Things aren’t going to be easy or convenient all the time. That’s life. It rains. You run late to work. They’re out of the thing you want at the grocery store. You have to change out your toothpaste. Ugh, inconvenience.

It was inconvenient paying a co-pay for the pill. I could have used that money on books for school or whatever. It is very possible that this case has in some way made your life inconvenient and you have to pay for something again.

But there is a difference between inconvenience and undue burden. Being charged taxes for something you have strong religious beliefs agaisnt? That’s unjust and undue burden. That’s really what Buwell v. Hobby Lobby is all about.

Now before you blow me off with the fact that churches and religious organizations benefit from tax breaks and tax money, just remember that secular and non-religious affiliated organizations do as well. And Christians in no way are allowed to avoid taxes. In the Gospels (Mark 12:17, Matthew 22:21, Luke 20:25), Jesus says, “Pay to Caesar what belongs to Caesar” aka pay your government what is due to your government. This is not the present issue.

In 1993, a federal law called the Religious Freedom Restoration Act was signed into law that planned to prevent future laws that would substantially burden a person’s free exercise of religion. Does a substantial tax penalty to provide something you have strong religious beliefs against count?

According to the Supreme Court recently, yes. This law was referenced may times in the opinion of the court.

Undue burden and religious freedom is part of the reason this country began. Our forefathers were being unfairly taxed by their government, and they fought back. Our forefathers wanted to practice their faith freely, and they fought back.

This is what Hobby Lobby did. The corporation faced a giant penalty for not paying for something they had strong religious beliefs against, and they won.

Remember: They only fought 4 of the 24 drugs mandated, the ones classified as abortifacients.  The Christian owners of Hobby Lobby believe a zygote has personhood. Thus, indirectly paying for drugs that induce abortion and violate the human dignity of the zygote is against their religious moral code.

For years upon years, the health care system has made exemptions for religious beliefs. I’ve worked with Amish people. They are charged differently since they do not carry health insurance due to their religious lifestyle. I doubt the ACA is changing that or would even think to burden them.

This religious respect should not end with Christians, however diverse our denominations and beliefs are. Just look at what each Christian denomination preaches about birth control. It’s quite diverse!

Maybe this whole case is uncomfortable because you have some affiliation with Christianity and don’t agree with the whole birth control thing or abortion thing, so it’s especially upsetting to you for whatever reason. That’s fine.

In fact, I think it’s great that you’re angry, frustrated, sad, confused, whatever. That means you’re really thinking about it, and that’s wonderful.

So, think on this: the birth control debate is not new. It’s been ongoing since even before the pill came out. In fact, it’s centuries old. There is literally a Bible passage about a man pulling out after having sex with his brother’s wife (Genesis 38:9). The idea of us wanting to control our lives and specifically fertility is not new in any way.

The abortion debate and respecting each person’s dignity is not new. The Bible is full of examples of people treating each other poorly. Heck, the first pope (aka St. Peter) cut off someone’s ear!

But life is inconvenient. Life is unpredictable. Life can be very scary because of those first two things. But that’s life. Burwell v. Hobby Lobby in no way stopped life. You’re still breathing, and the earth is still turning.

So, please, whenever you discuss Burwell v. Hobby Lobby, before you talk about reproductive rights and the war on women, really first consider inconvenience and undue burden. That’s what the case is truly all about.

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