Alcoholics Anonymous (AA) has been providing alcohol recovery services for eighty-plus years and has long been the recommended solution for individuals with an alcohol-dependency problem.

AA originally sprang from a Christian religious movement called ÔÇ£The Oxford Group,ÔÇØ and AA (and programs based on its model) use ÔÇ£higher powerÔÇØ imagery in its 12-step program model that can be alienating for nontheists and negatively impact their recovery. In fact, court-ordered AA is a violation of the Establishment Principle.

AA has benefitted many individuals, providing recovery programs vital to achieving individual behavior change. However, offering choice in recovery is important not only from a legal standpoint, but because research has shown that allowing choice in recovery programs results in enhanced outcomes ÔÇô especially when the program is selected based on the individualÔÇÖs needs and beliefs.

All 12-step programs have been judged ÔÇ£pervasively religiousÔÇØ in every federal appeals court and state supreme court that has reviewed pertinent cases. Recovery programs offered or permitted by the┬áfederal government such as drug court, prison, probation department, etc. which requires mandated attendance, such as that required in 12-step programs, must have a secular offering or are considered unconstitutional.

A growing number of mutual support recovery organizations do not require religious or higher power beliefs. Offering one or more of these programs in addition to the AA programs increases the probability for participant success. A list of these programs includes:

• Addiction Center┬áreviews top treatment centers and is a comprehensive resource hub and definitive guide to substance abuse.

• SMART Recovery participants learn tools for recovery based on the latest scientific research and participate in a worldwide community which includes free self-empowering, science-based mutual support groups.

• Women for Sobriety is a program for women with problems of addiction. It is the first and only self-help program for women only. WFSÔÇÖ purpose is to help all women recover from problem drinking through the discovery of self, gained by sharing experiences, hope and encouragement with other women in similar circumstances.

• LifeRing offers secular self-help to abstain from alcohol and non-medically indicated drugs by relying on a personÔÇÖs power and the support of others. LifeRing welcomes people from all faiths or none, and respects the fact that spiritual beliefs, if any, are personal.

• SOS – Secular Organizations for Sobriety and Save Our Selves takes a self-empowerment approach to recovery. SOS addresses sobriety as ÔÇ£Priority One, no matter what!ÔÇØ Guidelines for sobriety include: to break the cycle of denial and achieve sobriety, we first acknowledge that we are alcoholics or addicts.

POLICY RECOMMENDATION: Wherever recovery programs are offered or permitted by the government, a secular option must be available.

Religiously Based Child Abuse and Neglect

The U.S. Supreme Court has made it clear that the right to practice oneÔÇÖs faith does not extend to the point where childrenÔÇÖs health and safety are jeopardized. The Court ruled in Prince v. Massachusetts that parentsÔÇÖ religious beliefs do not give them a constitutional right to engage in practices that compromise a childÔÇÖs health or safety.

In his article, ÔÇ£The Children We Abandon,ÔÇØ William & Mary Law School Professor James G. Dwyer states that child abuse laws providing exceptions for perpetrators who deny children needed medical care for religious reasons ÔÇ£discriminate among groups of children, in the conferral of important state benefits, on an arbitrary and improper basis ÔÇô namely, the religious beliefs of other persons.ÔÇØ

Yet in 1996 Congress approved religious exemptions from the federal Child Abuse Prevention and Treatment Act (CAPTA). CAPTA now unconstitutionally discriminates against children whose parents belong to particular religious sects. CAPTA contradicts itself in that it requires parents to provide medical care for their children, but it also permits parents who believe in faith healing to withhold medical care. Thirty-seven states, the District of Columbia, and Guam have laws exempting parents or caretakers who fail to provide medical assistance to a child because of their religious beliefs from criminally liability.

POLICY RECOMMENDATION:┬áThe government has a parens patriae duty to protect our countryÔÇÖs children. States relinquish that duty and leave millions of children vulnerable to mistreatment when they include religious exemptions in child abuse and neglect laws.

EXCEPTIONS TO VACCINATION REQUIREMENTS

Vaccine mandates in the United States are generally confined to children enrolling in schools and daycares ÔÇô children mingling with large numbers of other children. These mandates have been effective in reducing mortality and morbidity. Instead of directly coercing parents to vaccinate their children, these mandates make enrollment conditional on vaccination.

Forty-eight states have religious exemptions and nineteen states have ÔÇ£philosophicalÔÇØ or ÔÇ£personal beliefÔÇØ exemptions from vaccines. Unvaccinated carriers lower the level of protection for everyone.

They especially place at risk babies too young to be vaccinated and those who, for medical reasons, are not vaccinated. But they also pose a risk to properly vaccinated persons whose immunity is compromised without their awareness of it. This was illustrated by a 2008 outbreak of five cases of HIB44 disease in Minnesota.

Proponents of such exemptions say unvaccinated persons pose no risk to vaccinated persons and argue U.S. vaccination rates are high enough to achieve herd immunity, a state when unvaccinated persons are protected from infection by the vaccinated individuals in a community. These arguments are false. Herd immunity is a misleading term; ÔÇ£herd effectÔÇØ would be more precise. Vaccinating the majority of group members does confer some protection on unvaccinated members, but many persons move from one ÔÇ£herdÔÇØ to another. Unimmunized children are not randomly distributed throughout a state nor are they always surrounded by vaccinated persons.

The number and percentage of parents claiming belief exemptions for their children has risen rapidly in the past decade, largely because of fears about vaccine safety, despite research which has shown vaccines to be safe. As vaccination rates have fallen, the number of measles and pertussis (whooping cough) cases has risen. In the U.S., children with personal belief exemptions are 35 times more likely to contract measles than properly vaccinated children. Public health officials have called upon legislators to make belief exemptions harder to obtain. Four states have passed laws requiring parents to listen to or watch medically accurate information about vaccines before being granted a belief exemption from immunizations for their children.

POLICY RECOMMENDATION: States should not endanger the public, especially children, through exceptions to state vaccination laws.

HEALTH AND SAFETY STANDARD EXEMPTIONS FOR RELIGIOUS CHILD CARE CENTERS

When parents place their children in a child care center, they expect the facilities to meet minimum health, safety, and caregiver-training standards set by law. But if that child care center is religiously affiliated, they may unknowingly be putting their children at risk.

Under the current federal funding system, if a child care center fails to meet the stateÔÇÖs health and safety standards for licensing, they can simply affiliate with a┬áchurch, religious institution or parochial school endorsed by a private religious accrediting agency, and be exempted from meeting those standards. Depending on the state, this can mean some of these child care centers are not regulated in relation to the following criteria:

• Minimum staff-to-child ratios;
• Minimum staff training requirement; and
• Various health, safety, and sanitation standards.

POLICY RECOMMENDATION:┬áState standards for child care centers that are designed to ensure childrenÔÇÖs health and safety and to provide parents with the assurance their children will be well cared for are important public policy. Exempting religiously affiliated child care centers from these requirements puts children at risk. Federal and state taxpayer dollars should benefit only those child care centers meeting all such health and safety standards.

CHILD ABUSE REPORTING EXEMPTIONS FOR CLERGY

The confidentiality of pastoral communications is fundamental, but not absolute and confidentiality must be balanced with childrenÔÇÖs essential rights to be free from abuse. Every state and the District of Columbia have statutes identifying those who are required to report child maltreatment under specific circumstances. However, in as many as 23 states and the District of Columbia, the law is unclear or absent in relation to whether clergy are mandated to report┬áchild abuse and maltreatment. In approximately 18 states, any person who suspects child abuse or neglect is required to report it.

About 27 states currently include members of the clergy among those professionals specifically mandated by law to report known or suspected instances of child abuse or neglect.54 Eight states and the District of Columbia do not require that clergy report known or suspected instances of child abuse or harm. Only nine states explicitly include Christian Science practitioners among classes of clergy required to report. This is an important fact because of the role faith healing can play in the medical neglect of children.

Religiously affiliated child care centers are not subject to the health and safety standards of state licensing laws, even though many are supported by taxpayer funds. Source: Applied Research Center (now Race Forward, The Center for Racial Justice Innovation), (2009) Categorizing the 14 states with exemptions for centers.

A 2012 investigative report by Tampa Bay Times found that the Florida Department of Children and Families has investigated over 165 allegations of abuse and neglect at unlicensed religious childcare homes in the past ten years, finding evidence to support allegations in 63 incidents with a list of offenses that include physical injury, medical neglect, asphyxiation and sexual abuse.

In 2007 a number of deaths at teen residential programs prompted a nationwide investigation by the Government Accountability Office of residential treatment programs for troubled youths, many of which set themselves up as licensing-exempt religious child care facilities. The report found the use of extended stress positions, days of seclusion, strenuous labor, denial of bathroom access, and death. Following the reportÔÇÖs release, the House passed legislation to give students access to child-abuse hotlines and to keep track of abusive staff members and reports of abuse, but with intervention from the religious right, the bill died in the Senate.

POLICY RECOMMENDATION: While the confidentiality of pastoral communications is well recognized, due to the unique and vulnerable position of children and the recent history of abuse of this pastoral privilege, religious communication must not be exempted from mandatory child abuse reporting statutes.

The use of stem cell and fetal tissue for contemporary medical research is a complicated moral issue. The decision as to whether or not to allocate federal funds to stem cell research should not be dictated by religious beliefs.

Human pluripotent stem cells, more commonly known as ÔÇ£stem cells,ÔÇØ are derived through two different methods. One method uses early stage embryos in excess of clinical need and donated by women undergoing in vitro fertilization. The other method isolates stem cells from aborted fetuses.

Stem cells have the ability to divide for an indefinite period in culture and can develop into most of the specialized cells and tissues of the body such as muscle cells, nerve cells, liver cells and blood cells. The use of stem cells has far-reaching possibilities including ÔÇ£cell therapies.ÔÇØ Stem cells stimulated to develop into specialized cells could be used to treat diseases such as ParkinsonÔÇÖs, AlzheimerÔÇÖs, spinal cord injuries, stroke, burns, heart disease and diabetes. Using stem cells could reduce the dependency on organ donation and transplantation.

The moral issues raised by stem cell research differ, depending on whether the cells come from aborted fetuses or embryos resulting from in vitro fertilization that are no longer needed for infertility treatment.

The ethical acceptability of deriving stem cells from the tissue of aborted fetuses is closely connected to the morality of abortion. Research using stem cells obtained from human embryos poses moral difficulties that do not exist in the case of fetal tissue.

POLICY RECOMMENDATION: Government policy on the use of stem cells for medical research should be based on scientific and medical research, with discussions of shared values free of sectarian influence.

Introduction

There are complicated moral and ethical questions involved in womenÔÇÖs health issues and access to health care for theists and nontheists alike. However, the particular influence of sectarian religious belief on government policy regarding women suggests a government endorsement of particular religious beliefs to the exclusion of minority and non-theist views.

ABORTION BANS

In the landmark case Roe v. Wade, the U.S. Supreme Court recognized that the U.S. Constitution protects a womanÔÇÖs right to make her own medical decisions, including her decision to have an abortion. Therefore, a state may not ban abortion prior to viability. In the 40 years following that landmark ruling, in decisions including Casey v. Planned Parenthood of Southeastern Pennsylvania, the Supreme Court has never wavered from this principle.

Yet the nationÔÇÖs most extreme bans on abortion were passed by various state legislatures in 2013. The Arkansas legislature overrode Governor Mike BeebeÔÇÖs veto of a bill banning abortion at 12 weeks, and North Dakota banned abortion at 6 weeks. Abortion bans are not only bad policy because they prevent a woman from making her own personal, private decision about her health and medical care, but because they violate womenÔÇÖs constitutional rights.

NON-SURGICAL ABORTION

Women in the United States have been safely and legally using non-surgical abortion for years, but anti-womenÔÇÖs health activists have devoted significant attention to creating barriers and restrictions to block access.

Bills restricting non-surgical abortion are being considered in states ranging from North Carolina to Arkansas to Missouri and Mississippi. In states where these restrictions have been passed, some women have been forced to have a surgical procedure when they would have chosen non-surgical abortion instead.

Non-surgical abortion gives a woman the option of a more private, less invasive method of ending a pregnancy, in a setting in which she feels more comfortable. With a medical professional, she decides when the abortion starts, where it should happen, and who should be with her while it is happening. She has access to medical professionals 24 hours a day, seven days a week if she has any questions or concerns. One in four women uses this method, and if a woman follows the instructions provided, there are no risks to her future fertility.

POLICY RECOMMENDATION:┬áLaws and regulations of womenÔÇÖs healthcare must be based on scientifically sound medical research and driven by a compelling government interest, not sectarian religious beliefs.

BIASED COUNSELING

A woman should have accurate information about all her pregnancy options. Information should support a woman, help her make a decision for herself, and enable her to take care of her health and well-being. It should not be provided with the intent of shaming or coercing her toward any particular decision.

Recent bills propose mandatory waiting periods, mandatory ultrasounds, and could force doctors to provide state-mandated, ideological scripts to their patients. A recent evaluation of TexasÔÇÖ 2011 biased counseling law found the law does not enhance health information, but rather places unnecessary hurdles before a woman can make a private medical decision. The law has the compound effect of making a woman feel ashamed and adds additional costs to a safe and legal procedure.

POLICY RECOMMENDATION: Access to scientifically accurate, unbiased, timely information about reproductive health and pregnancy options should not be obstructed by religiously motivated legislation or regulations.

HEALTH CARE PROVIDER REFUSAL LAWS

Following the U.S. Supreme CourtÔÇÖs 1973 decision in Roe v. Wade, several states and the federal government enacted health care provider refusal laws (ÔÇ£Refusal LawsÔÇØ). These laws allowed medical professionals to decline participation in abortion-related services. Congress passed the Church Amendment, which permitted any health care facility or provider receiving federal funds to refuse to provide abortion services and sterilization services if doing so violated the providerÔÇÖs religious or moral beliefs. The District of Columbia and 46 states have statutes allowing medical professionals to refuse to provide abortion services.

Religious refusal exemptions, also known as ÔÇ£conscience clausesÔÇØ allowing health care providers to decline to provide lawful services that conflict with their religious or moral beliefs, must balance the providerÔÇÖs conscience claims with the patientÔÇÖs right to care, privacy, and self-determination.

Conscience clauses should apply only to individual providers and not their places of employment: all secular health care institutions and business entities serving the public should guarantee the presence of medical professionals willing and able to provide all lawful health care services requested or required by patients. If an organization chooses to establish itself as a secular business, operating in the secular marketplace, it should abide by secular law.

More recently, Refusal Laws have expanded into the area of prescriptions and to pharmacists themselves. At least 12 states have laws allowing a pharmacist to refuse to fill lawful prescriptions for drugs that the individual considers ÔÇ£abortifacientÔÇØ, including emergency contraception prescriptions.However, when some states tried to impose an affirmative duty on pharmacists to dispense emergency contraception, federal courts held that these mandates violated the pharmacistsÔÇÖ rights under the Free Exercise Clause of the First Amendment and the Equal Protection Clause of the Fourteenth Amendment.

Refusal Laws can be challenged on the basis of their conflict with the right to privacy of the individual.35 A female is denied the right to decide whether to use contraception when a pharmacist denies her right to have it. These laws also raise issues of Equal Protection. When the law allows pharmacists to refuse to fill contraceptive prescriptions, it sanctions unequal treatment of men and women. More practically, issues of access are raised, especially for women in low-income or rural areas, for whom a refusal to dispense may cut off access to contraceptives entirely.

POLICY RECOMMENDATION: Patients should not be denied medical care through laws that allow medical professionals to deny patients abortion and sterilization procedures (or other services), and enable pharmacists to refuse to fulfill lawful prescriptions for contraception including emergency contraception.

RELIGIOUS EXEMPTION FOR CONTRACEPTIVE CARE

The contraceptive coverage requirement of the Affordable Care Act is intended to serve the compelling public health and gender equity goals and is in no way targeted at religion or religious practices, keeping in line with First Amendment jurisprudence. However, the Department of Health and Human Services announced a broad religious employer exemption to include all non-profit organizations that claim a tax exemption as a ÔÇ£religious employer.ÔÇØ This criterion is ripe for abuse because any organization can claim it, without any requirement of proof.

This exemption sets the precedent that the religious interests of a few employers come ahead of immense health and social benefits of all Americans. Specifically, the exemption will have a significant impact on American women across a wide spectrum of the workforce. Millions of American women are employed by non-profit organizations, particularly with non-profits that are commonly religiously affiliated such as schools or hospitals.

These women are entitled to earn a living without sacrificing their health and their own religious liberty. Although the current exemption is vague and overly broad, cases are working their way through the courts from for-profit employers claiming the religion of the boss dictates the health care choices of the employees. Claimed religious objections to federal law by founders of for-profit businesses do not entitle those businesses to violate laws that protect their employees.

POLICY RECOMMENDATION: Religious exemptions from a neutral law of general applicability such as the contraceptive coverage in healthcare plans should be limited only to houses of worship in regards to employees with ministerial duties.

The Right to Die movement, launched in 1976, has its foundation in two court decisions. In re Quinlan, the New Jersey Supreme Court ruled unanimously to appoint Karen Ann QuinlanÔÇÖs father her legal guardian with the authority to make medical decisions on her behalf, including the removal of life-sustaining treatment. With this decision, competent persons or their legal guardians obtained the legal right to refuse medical treatment. Ten years later, in Cruzan v. Director, Missouri Dept. of Health, the U.S. Supreme Court clarified that a legal guardian could request removal of life support by providing ÔÇ£clear and convincing evidenceÔÇØ of its necessity. The Terri Schiavo case, involving multiple court cases, motions, and appeals between 1990 and 2005, set no new legal standards for the Right to Die movement and affirmed decisions set out in Quinlan and Cruzan.

A contemporary offshoot of the legally established Right to Die movement is the Death with Dignity movement, calling for state policies allowing a terminally ill, medically competent adult to request and receive prescription medication to hasten death. Three states have such policies (Oregon, 1994 and 1997), Washington (2008), and Vermont (2013). The Montana Supreme Court determined there was no state law banning the prescribing of medications to hasten death for terminally ill individuals, effectively validating the practice in 2009. Montana state law also bars prosecution of doctors who help terminally ill patients end their lives. The Oregon Death with Dignity Act is considered model legislation by the movement, and a careful reading of 15 years of data published by the Oregon Health Authority demonstrates its legitimacy as a state policy.

Proponents of the Right to Die and the Death with Dignity movements argue for the principles of self-determination and autonomy. They believe an individual, acting alone or through a legal guardian, has a right to choose what happens to his or her body.

Supporters argue one hallmark of an ethical society is the option of a compassionate and dignified end to suffering.
Much of the opposition to the Right to Die and Death with Dignity movements arises out of religious beliefs, particularly those rooted in the tenet of the sanctity of life. Such arguments assert the practice is akin to suicide, positing an ethical society should not condone suicide in any situation. Secularly based arguments question the legitimacy of the policy, arguing risks of coercion on vulnerable populations. Some physician opponents, including organized medicine, suggest it is antithetical to a physicianÔÇÖs role as healer to end life.

The Supreme Court has ceded policy decisions about the right to die to the states. While declining to recognize a constitutional right to assisted dying, the Court has held that state laws allowing physician-assisted dying trump the U.S. Attorney GeneralÔÇÖs power to regulate controlled substances. In 2012, a slim majority of Massachusetts voters rejected a ballot question that would have legalized physician assisted dying after an aggressive campaign by the Roman Catholic Church.

Public opinion about hastened dying has been tracked by both the Harris and Gallup polling firms. A 2011 Harris Poll reported strong national support for Death with Dignity, with 70% of respondents indicating agreement with the following statement: ÔÇ£Individuals who are terminally ill, in great pain, and who have no chance for recovery, have the right to choose to end their own life.ÔÇØ A minority (17%) opposed the statement, 8% were not sure, and 4% declined to answer the question. More recently, Gallup explored the issue in relationship to the use of the word ÔÇ£suicideÔÇØ in polling questions. This poll found majority support, concluding, ÔÇ£Americans generally favor allowing doctors to assist terminally ill patients in ending their lives, but the degree of support ranges from 51% to 70%, depending on how the process is described.ÔÇØ

POLICY RECOMMENDATION: Religious arguments made against the Right to Die and Death with Dignity are personal beliefs and should not set public policy for all Americans.