That's the question before courts in New York and California, which are being asked to exempt branches of the Catholic Church from state laws requiring that contraceptives be included in employee prescription-drug plans. Under church doctrine, contraception is a sin.
"The Catholic Church explicitly teaches that artificial contraception is morally unacceptable and, if knowingly and freely engaged in, sinful," Catholic Charities of Sacramento attorney James Sweeney said.
After California's law was enacted in 2000, the group unsuccessfully sought a ruling to bar the law from being enforced on the church's charity-outreach programs. A state appeals court also denied the church relief. The California Supreme Court is to hear the case tomorrow.
Versions of the law have been adopted in 20 states, including Washington, after lawmakers concluded private employee-prescription plans without contraceptive benefits discriminated against women. Lawyers following the debate said the only other challenge is before a lower-court judge in Albany County, N.Y.
California's case is years ahead of the New York litigation; and civil-rights groups, health-care companies and Catholic organizations have filed extensive position papers with the court.
"It certainly could be very persuasive on other courts," said Rebekah Diller, a New York Civil Liberties Union director.
At issue is a collision of the right of a religion to practice what it preaches and the rights of thousands of women employed by church-affiliated groups to be insured for contraceptives.
Catholic Charities directly employs more than 1,000 workers in California and New York, but a ruling favoring the charity also could apply to more than 100,000 employees at 77 church-affiliated hospitals in California and New York.
State regulators note U.S. Supreme Court rulings in favor of a ban on polygamy, despite objections from Mormons, and against Native Americans who were denied unemployment insurance after being fired for using peyote during religious ceremonies.
"The church's claim that it is coerced into violating its religious beliefs by a state law requiring health-insurance plans and disability policies to include prescription contraceptive coverage is nonsense," California Deputy Attorney General Meg Hollaran said.
The two states note that churches are exempt from having to provide contraception coverage for employees who work inside parishes and houses of worship. That is known as the "religious employer exemption" because the parishes generally employ those with similar religious views.
Several states have no such exemptions for religious entities.
Catholic Charities had a $76 million budget in California last year and provided social services to people of any religion or background. It does not demand that its workers be Catholic or share the church's philosophy.
Sweeney called the law "un-American and disturbing" because of its "disrespect of religious, moral views."
Sweeney noted that the nation's military allows for the religious views of conscientious objectors, by keeping them off the front lines, and that laws demanding certain traffic-safety markings on Amish buggies have been nullified because they trod on the Amish lifestyle.
An attorney for the American Civil Liberties Union argued that siding with the Catholic Church would, in essence, impose the church's doctrine on thousands of non-Catholic women who work at the church's hospitals or social-service agencies.
"Catholic Charities' noncompliance with California law would injure three fundamental rights of the people who work for the social-services agency: gender equality, reproductive autonomy and religious freedom," attorney Margaret Crosby wrote in a brief to California's high court.
The American College of Obstetricians and Gynecologists views the dispute as a health issue. Contraception gives women a chance to plan for a pregnancy, which the groups say makes for healthier mothers and babies.
"To ignore the health benefits of contraception is to say that the alternative of 12 to 15 pregnancies during a woman's lifetime is medically acceptable," said Catherine Hanson, the groups' attorney.