(MADISON, WIS.) The Freedom From Religion Foundation will appeal this week's unfavorable ruling by a federal district judge, approving the pervasive integration of religion and spirituality into all aspects of taxpayer-supported healthcare for veterans. VA policy now dictates that religious and spiritual needs go hand-in-hand" with medical care.
U.S. District Judge John Shabaz, for the Western District of Wisconsin, ruled on Jan. 8 that the policy change at the Department of Veteran Affairs, integrating religion and "spirituality" into all aspects of medical care, is permissible because it is "voluntary."
"We believe it is unconscionable that vets are being told that they must have a 'spiritual assessment' as part of routine health care, that such an assessment must take place, for instance, simply in order to be referred to an eye doctor!" responded Annie Laurie Gaylor, co-president of the 8,200-member, Madison, Wis.-based national association.
The Foundation's federal lawsuit challenged chaplaincy changes at the VA, which went from the traditional accommodation of the free-exercise rights of hospitalized veterans to full-scale, obtrusive chaplaincy services and assessments upon all patients, including outpatients who have no free-exercise burden.
The Spiritual Assessment Inventory, provided by the government to all VA chaplains, includes four categories: (1) Organized Religious Activity Scale, (2) Subjective Religious Scale, (3) Non-organized Religious Activity Scale, and (4) Spiritual Injury Scale. A score of 15 or lower indicates the patient should be referred to chaplain services.
The assessment form includes the following language: "completing this assessment questionnaire will help us to better understand your spiritual care needs. We believe that faith plays an important role in a person's sense of health and wellness."
"When the government writes and distributes such an assessment, how can this not show government endorsement and preference for religion?"asked Dan Barker, Foundation co-president.
Gaylor and Barker noted the Foundation's appeal will be based in part on the fact that coercion is not required to show that a governmental action violates the Establishment Clause of the First Amendment. Aside from the legal definition of coercion, they said the VA practice improperly places the burden on a patient to decline the spiritual assessment, and invades patient privacy. Assessments often ask detailed questions on belief in a god, churchgoing, bible-reading, etc.
Barker and Gaylor, who are taxpayer plaintiffs in the lawsuit, also objected to the judge's undocumented reference to "research" allegedly showing that prayer and religion aids recovery. They also challenged the judge's statement that the chaplaincy programs could "reduce operating costs," and therefore have a secular purpose.
Shabaz recited without criticism the fact that "many of VA's treatment programs integrate religion and/or spirituality into their protocol by: (1) using Lament and Faith Development, (2) teaching the Twelve Steps of Alcoholics Anonymous; or (3) bringing the spiritual components of faith and God's grace to bear on treatment."
" 'God's grace' is a phrase that has no secular meaning or purpose," Gaylor pointed out, and should not be part of a government program. The VA contends "spirituality" can deal with "the meaning of life," not just religion. Gaylor said, "While there is meaning in life, there is no overarching 'meaning of life' in a nonreligious sense."
Barker took issue with a statement in the decision that the "government is not constitutionally required to be hostile to religion." He added: "We seek neutrality."
Shabaz inaptly compared the spiritual care to a "voucher." Shabaz wrote that "to establish governmental indoctrination plaintiffs must establish that any religious indoctrination reasonably be attributed to governmental as opposed to private action."
"This is precisely what the Foundation has documented. It is disingenuous to paint the integration of religion at the VA as a 'private action' or 'at the wishes of the patient' when it is VA policy to require assessments for everyone, including outpatients," Barker said. "They tell patients spiritual assessments are necessary for good health, and make a spiritual assessment unless a patient actively declines. While VA policy forbids proselytization, the VA admits it does not monitor chaplains--because that would be an 'entanglement' of religion and government! Yet integrating religion and spirituality into all healthcare is not an entanglement?"
The Veterans Health Administration is the nation's largest integrated health system, with an annual medical care budget of more than $30 billion, serving a nationwide network of more than 157 hospitals, 870 outpatient clinics, 134 nursing homes and other centers.
The lawsuit was filed last spring and named VA Secretary R. James Nicholson; Undersecretary for Health Jonathan Perlin, M.D.; Hugh Maddry, director, and A. Keith Ethridge, deputy director, of the National Chaplain Center; and Jeni Cook, program manager of the Spiritual Health Initiative.
Plaintiffs are the Freedom From Religion Foundation, Foundation co-presidents Dan Barker and Annie Laurie Gaylor, and Anne Nicol Gaylor, president emerita, as federal taxpayers. They are represented by attorney Rich Bolton.