The Dominican Sisters of Hawthorne have given free care to the dying poor for 125 years — no fees, no insurance, no government money, not even a donation accepted for twenty years after a patient’s death. New York State has decided that is not enough. Under Governor Kathy Hochul’s Medical Aid in Dying law, the sisters must now present assisted suicide as an option to their patients or face the consequences of refusal. As Kathryn Jean Lopez reports in National Review, Becket, the religious-liberty law firm, is representing the Dominicans and three other Catholic plaintiffs in a constitutional challenge arguing the law violates the First Amendment five times over. The MAID law’s religious exemptions are among the narrowest in the nation — narrower than California’s, Oregon’s, Washington’s — and they do not apply at all to independent assisted-living facilities. A government that exempts individual physicians but compels the institutions they practice in has not crafted a compromise. It has engineered a compliance trap.
Lopez is right. The case is an outrage. And the Dominican Sisters are not merely a religious community. They are the thing the conservative movement claims to exist to defend. A community of practice — rooted, voluntary, governed by a charter older than any state regulation — providing care that no market would price and no bureaucracy would replicate. Mother Mary Alphonsa, Nathaniel Hawthorne’s daughter, began with two rooms on the Lower East Side because a seamstress died alone of cancer and the economy offered her nothing. The sisters do not take insurance because insurance would require them to comply with the very bureaucratic logic they exist to refuse. Their patients are people the economy has finished with. The sisters have not finished with them.
A defender of the law would say its narrow exemptions represent an honest attempt to balance a patient’s autonomy against a provider’s conscience. Perhaps — but a law that exempts the individual physician and compels the institution where he practices has not balanced anything. It has placed its thumb on the scale. The “opt-out” that does not apply to independent assisted-living facilities is not a compromise. It is a closing of the exit.
That is the mediating institution. That is subsidiarity in the flesh — a community of women answering a call, governing themselves, providing care at the lowest and most human level, without state funding or state permission. Pius XI called it a “grave evil” when higher bodies absorb what lesser organizations can do. The sisters are what subsidiarity looks like when it is not a paragraph in an encyclical but a woman bringing soup to a patient who has no one else.
So where is the movement that claims to defend them? Becket is in the courtrooms, and to its credit. Lopez is on the op-ed pages, and to hers. But the movement — the broad institutional right that calls itself conservative, the party of local control and family values and mediating institutions — has spent forty years dismantling the world that produces Dominican Sisters.
The parish is where vocations begin. The parish is where a girl first sees women in habits, where a community gathers around something older than any of its members, where the call to religious life becomes imaginable. Across New York State, the rooted Catholicism that sustained orders like the Hawthorne Dominicans has been thinned by diocesan closure after diocesan closure — the same managerial logic that now tells a nursing home it must offer its patients the option to die. And the economy that sustains the communities around those parishes? The conservative movement’s own economic program — financialization, consolidation, the rentier conversion of working places into leisure destinations — has dissolved it. The factory towns where Catholic immigrants built parishes and hospitals and nursing homes have been hollowed out by the very forces the movement champions. The family farms that filled the pews have been consolidated into operations growing potatoes for snack-food giants on center-pivot ground where families once made a living. The paper mills that employed the men and women who donated to the Dominican Sisters idled and closed. The conservative movement did not do this with malice. It did it with indifference, which is worse, because indifference does not require a decision. You simply stop defending the rooted things and let the spreadsheet do the rest.
I used to trade the futures on the crops these consolidated operations now grow. I know the mechanism. The commodity trader does not see the parish. He sees the contract, the basis, the carry. The financialized farmer does not see the nursing home. He sees the yield per acre and the contract price with PepsiCo. The entire architecture of the rentier economy is designed to make the rooted thing invisible — to render the parish, the nursing home, the community of practice into externalities that do not appear on any balance sheet. And the movement that claims to defend religious liberty has no economic grammar for any of it. It will go to the Supreme Court for the First Amendment and go home to a platform that accelerates the very consolidation that dissolves the social base of the institutions it defends.
This is fusionism’s final irony. The marriage of free-market economics with religious conservatism produced a movement that can defend the sisters’ right to refuse assisted suicide but cannot defend the community that gave them their calling. It can argue the First Amendment but cannot argue the encyclical. It can win the Becket case and lose the world, because it has no theory of the mediating institution that survives contact with its own economic program.
The counter-model is already there, and it has been there for 125 years. It is the Dominican Sisters themselves — a community of practice, self-governing, rooted in a place, answering to a charter that predates any state regulation, providing care that no market would price and no bureaucracy would replicate. The Catholic Worker house of hospitality that Dorothy Day founded during the Depression — still feeding and sheltering people the economy has discarded, still answering to a rule no state wrote and no market funded — is the same principle at street level. The cooperative dairy where the farmers who do the work own the plant and set the price, answerable to each other and their neighbors rather than to a hedge fund that has never seen a barn, is the same principle in the economy. What would actually defend the sisters — what would make their existence possible in another century — is not a Supreme Court ruling, though that would help. It is subsidiarity as a way of life, not a legal argument. It is a conservatism that defends not only the sisters’ right to refuse the state’s mandate but the parish that nurtures vocations, the town that sustains the parish, and the economy that sustains the town.
The sisters will cross the threshold of Rosary Hill tomorrow morning and bring comfort to patients the economy has discarded. They have been doing this since 1901. Whether the movement that claims to defend them will do anything to ensure they can do it for another 125 years is the question. So far, the answer is: win the case, lose the world.