The Catholic Church in the United States has a significant presence in the provision of healthcare. Indeed, the service provided by the Church was often the first healthcare service available in many communities. During a pastoral visit to this country in 1987, Pope John Paul II spoke to the annual assembly of the Catholic Health Association. He stated to the group that: "Your healthcare ministry, pioneered and developed by congregations of women religious and congregations of brother, is one of the most vital apostolates of the ecclesial community and one of the most significant services which the Catholic Church offers to society in the name of Jesus Christ."

 Constituted by the Church, the healthcare apostolate functions in a civil state and with its laws. Among the concerns of the Church are protecting the integrity of its apostolates. As laws veer further from Christian morality, the Church must engage the legislative process to protect the mission. Accordingly, one instrument useful in balancing the constitutionally protected rights of the Church and its ministry is that of the "conscience clause" in legislation, or, alternatively, separate pieces of legislation to protect the conscience rights of religious healthcare providers.

 An example of this is seen in the State of Illinois, which is one of 14 states that requires commercial managed care contracts provide a range of "advanced reproductive technologies" to assist infertile couples. The moral problem arose from the State mandated inclusion of, among other procedures, in vitro fertilization (IVF).  IVF is morally objectionable because it separates the unitive from the procreative dimensions of human sexuality -- new life comes to be outside the human body; and b/ regularly results in excessive numbers of fertilized eggs, which are considered "surplus" and discarded (abortifacient action).

 How could a Catholic healthcare entity operate an insurance component (HMO) in such an environment?  Catholic healthcare might find that, given the turbulence in healthcare today there is need to have their own HMO. Yet, the state requirement of a list of procedures would be morally offensive.

 The Illinois Catholic Conference had, a decade ago, worked with other religious bodies and legislators to enact a "Right of Conscience Act."   It protected medical providers -- hospitals, physicians and nurses -- but not religious organizations that have a payment/insurance component. The Catholic Conference developed an amendment for the update of the well-established conscience act.

 The state conference put together the right amendment language at the right time and with the right educational outreach to show that the current situation presented new needs. The legislature scheduled hearings in the two houses of state government and accepted the amendment, which was signed by then Governor Edgar in 1997. During the hearing process tough questions arose but ultimately there was the recognition of the sound constitutional basis for his amendment.

 Under the American constitutional structure, Catholic healthcare has a right to enter the public forum, like any other entity, to protect its integrity. It is essential that we act in a timely manner to protect this important service offered by the Church in the Name of the Lord.