Sister Bernice Fletcher will long remember this day. At least, that's what she tells herself as she puts down the letter. The CEO of a Catholic health system with more than 38,000 employees and several hundred sites of care in cities and small towns across the Midwest, she finds herself thinking that things were much simpler in the old days, before the Religious Sisters became a system, when it was just one hospital with a small staff. In the old days, all of the nurses and many of the supporting staff members (the cafeteria personnel, the med techs, even some of the aides) were nuns. Sister Bernice sighs and picks up the letter again. She reads:
We, the gay and lesbian employees of three urban hospitals within the Religious Sisters Health System, seek fairness in benefits for our long-term partners. As employees, we have put many years into expressing the values of the system's mission. Though we are small in number, we believe that our partners and our partners' children ought to be eligible for the same benefits for which married persons are eligible. And we believe that Church teaching mandates access to care for the disenfranchised and that therefore the Religious Sisters hospitals cannot, in good conscience, turn our partners away.
Putting the letter down for the second time, Sister Bernice picks up the phone and dials Dr. Louis O'Leary, the chair of the system's ethics committee.
"Good Lord!" says the chair. "We can't give these people benefits! What will the Bishop say?"
There is a pause as Sister Bernice marshalls her response. "I don't know the answer to that right now. All I know is, we can't afford to lose good employees. Not in this market."
"But same-sex marriages aren't even legal! How can we sanction a union that isn't recognized by state law? Let alone God's law."
"I don't know that we are going to sanction it."
"And what about the added financial burden on the system? If we do this, what's next? Where do we set the limits? What constitutes a committed relationship if there's no legal bond?"
"Louie, all I can say right now is, we're going to have to convene the committee to look into it."
"Fine. But the Bishop isn't going to like this. And neither are a lot of Catholics out there."
Sister Bernice puts down the phone and sighs again. She will ask the system-wide ethics committee to review the situation, but she will also pursue her own study by using external professionals trained in health-care ethics.
The gay employees' letter raises fundamental questions for this system and for religious healthcare ethics in general. Does a healthcare system with specifically religious affiliations have a different set of moral obligations from that of an explicitly nonreligious system? How is the moral analysis different when conducted on the basis of religious ethics as opposed to explicitly nonreligious ethics? The following is a summary of the moral arguments contained in the healthcare ethics consultant's report to Sister Bernice on the issues raised in the gay and lesbian employees' letter.
"It's not legal." The thrust of this argument is that if same-sex marriage is not legal, the system has no moral obligation to provide health benefits. Yet some corporations have taken the opposite tack and interpret the law's nonrecognition of same-sex partners as the reason for an organization's stronger moral obligation to provide benefits. The argument is that same-sex couples have no legal remedy when they are denied benefits, and that discrimination based on sexual preference and sanctioned by the law creates the need for moral redress by the organization. Some organizations have used this pattern of reasoning to offer benefits to same-sex partners only and to exclude opposite-sex partners who could avail themselves of marriage and benefits. To the chagrin of those ethics committee members who equate illegality with absence of moral obligation, the argument for moral redress supports the conclusion that when the law is unjust, illegality grounds the obligation.
"It will cost too much." The ethics committee at Religious Sisters agreed that this argument could only be settled by facts. A review by William Mercer, a benefits consulting group, indicated that more than 600 major private U.S. corporations, including 15 Fortune 100 companies and 35 Fortune 500 companies, now offer some form of "spousal-equivalent" benefits, or in some cases more comprehensive "domestic-partner benefits." The 600 corporations saw a .01% increase in their health care costs. Bell Atlantic, which has more than 100,000 employees in the mid-Atlantic region, now offers the benefit to 233 employees for an annual increase of .07% in spending. To limit financial risks, organizations establish eligibility criteria, such as living together for a set time in a permanent residence and joint responsibility for each other's welfare and expenses. In general, the demand is not as great as anticipated, though there are indeed some additional costs.
"It would undercut, not promote, the organization's mission and philosophy." Here the moral arguments press in different directions, depending on whether they are nonreligious or religious. From a nonreligious perspective, the arguments in favor of same-sex partner benefits are strong in appeals to pragmatism, fairness, and diversity. Pragmatically, an organization needs workers to fulfill its mission, and offering partner health benefits is a means of attracting and retaining workers — the competition demands it. From an ethical perspective, the practice promotes the value of fairness, a value much cherished in the world of business. One requirement of fairness is nondiscrimination, treating similarly situated persons equally. Same-sex partners can be similar in every aspect to married couples: loyal employees, in committed relationships, and encumbered with the financial burdens of the partner's medical care. Yet employees in same-sex partnerships are denied treatment equal to that provided to similarly situated married employees. Equal treatment offers a moral rationale for equal benefits.
Healthcare organizations also promote the value of diversity in the workforce for several reasons. Creating an environment where diverse workers perceive they are treated fairly and with respect increases job satisfaction, which is thought to have a high correlation with improved patient satisfaction and increased market share. An organization that expects employees to respect each other's differences (including sexual orientation) yet adopts policies that discriminate against those who choose same-sex partners could be perceived as hypocritical. Inconsistent policies erode moral authority and lower the morale of workers. So both a pragmatic and a moral case may be made in favor of same-sex partner benefits.
Religious considerations may turn this moral obligation upside down, depending on the tradition. In this case, where the tradition is Catholic, the teaching authority speaks against homosexual acts and out-of-wedlock relations. Appeals by gay and lesbian workers to Catholic social teaching or to equal and fair treatment would meet counter arguments that Catholic institutions have no moral obligation to respect interpersonal relationships that cannot be sanctioned morally (i.e., homosexual partnerships). No sanction means no moral obligations, including benefits. Other religious traditions with positions ranging from mild accommodation to all-out acceptance of same-sex or domestic-partner relationships might support conclusions similar to those arrived at by common human morality.
The members of an ethics committee at a religiously based institution will have to answer for the extent to which they should promote the moral reasoning of the institution that employs them. The real question in this case may be, Can one ethics committee or even one system act in outright defiance of institutional teaching? If, for example, the committee arrives at a position that is contrary to Roman Catholic authority, it may find itself up against a value system so firmly in place that all arguments are likely to be moot.
