Opponents of conscience protections for Catholic Health Care institutions claim that, since institutions are not autonomous individuals, they are not subjects of conscience. Therefore, since institutional conscience does not exist, it does not deserve protection. In this article, the author demonstrates not only that institutional conscience exists but that it is an activity that pervades all human institutions. He provides a metaphysical sketch that illustrates how institutions are organic outgrowths of human social nature which mitigate the natural limitations of human individuals. Consequently, the activity of conscience is inherently a component of the life of human institutions.

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Catholic healthcare institutions live amidst tension between three intersecting primary values, namely, a commitment of service to the poor and vulnerable, promoting the common good for all, and financially sustainability. Within this tension, the question sometimes arises as to whether it is ever justifiable, i.e., consistent with Catholic identity, to place limits on charity care. In this article we will argue that the health reform measures of the Affordable Care Act do not eliminate this tension but actually increase the urgency of addressing it. Moreover, we will conclude that the question of limiting charity care in a manner that is consistent with the obligations of Catholic identity around serving the poor and vulnerable, promoting the common good, and remaining financially sustainable is not a question of if, but of how such limits are established. Such limits, however, cannot be established in light of one overriding moral consideration or principle, but must be established in light of a multitude of principles guiding us to a holistic understanding of the interrelatedness of the moral dimensions of Catholic identity.

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