The pope mentioned “religious freedom” in the third sentence of his Jan. 19 remarks at the Vatican and he never let up — returning to this hot topic again and again.

The bottom line, he said, is that America’s once strong political consensus has “eroded significantly in the face of powerful new cultural currents which are not only directly opposed to core moral teachings of the Judeo-Christian tradition, but increasingly hostile to Christianity as such.”

It doesn’t matter if these attacks originate in “radical secularism,” “radical individualism,” a “merely scientific rationality” or suppressive forms of “majority rule,” said Benedict, during one in an ongoing series of meetings with American bishops. Catholic leaders must strive to defend church teachings in ways that reach all believers in their care — including Catholic politicians.

Within a matter of hours, these American bishops had good cause to reflect on one Benedict passage in particular.

While he didn’t name names of cite issues, the pope noted that of particular Vatican concern are “attempts being made to limit that most cherished of American freedoms, the freedom of religion. Many of you have pointed out that concerted efforts have been made to deny the right of conscientious objection on the part of Catholic individuals and institutions with regard to cooperation in intrinsically evil practices. Others have spoken to me of a worrying tendency to reduce religious freedom to mere freedom of worship without guarantees of respect for freedom of conscience.”

The next day, Health and Human Services Secretary Kathleen Sebelius — a liberal Catholic — announced that the Obama administration would not back down on its new rules requiring the majority of church-based institutions to include all FDA-approved forms of contraception in the health-insurance plans they offer to employees and even students. This would include, with no out-of-pocket payments, sterilizations and the contraceptives — abortifacient drugs — commonly known as “morning-after pills.”

“Scientists have abundant evidence that birth control has significant health benefits for women and their families, it is documented to significantly reduce health costs and is the most commonly taken drug in America by young and middle-aged women,” announced Sebelius. The administration’s decision was made “after very careful consideration, including the important concerns some have raised about religious liberty.”

In a concession that further infuriated her critics, she said some religious institutions could apply for a one-year delay in complying with the rules.

The president of the U.S. Conference of Catholic Bishops was not amused.

“In effect, the president is saying we have a year to figure out how to violate our consciences,” said Cardinal-designate Timothy Dolan, archbishop of New York, in an online video. “To force American citizens to choose between violating their consciences and forgoing their healthcare is literally unconscionable. It is as much an attack on access to health care as on religious freedom.”

Pro-Vatican Catholics were united in their opposition to the new regulations, which also drew fire from conservative Protestants and Jews. At the same time, the struggle provided fresh evidence of painful divisions among American Catholics, including the reluctance or refusal of many Catholic institutions to defend church teachings. For example, a mere 18 Catholic colleges — out of nearly 250 nationwide — united for an earlier protest of the proposed HHS regulations.

“Some Catholics will hear this news with mixed or negative emotions, including many bishops,” noted Dr. Patrick Whelan, of the Catholic Democrats organization. “At the same time, we know Catholic women, and by extension their families, use oral contraception at the same rate as the overall population. For over half a century, since the issuance of Humanae Vitae, Catholics and Catholic theologians have taken issue with the Church’s teaching on birth control.”

Meanwhile, a cardinal long admired by progressive Catholics added his voice to the chorus of those who were outraged.

“I cannot imagine that this decision was released without the explicit knowledge and approval of President Barack Obama,” said retired Cardinal Roger Mahoney of Los Angeles, on his weblog. “I cannot imagine a more direct and frontal attack on freedom of conscience than this ruling. … For me the answer is clear: we stand with our moral principles and heritage over the centuries, not what a particular Federal government agency determines.”

In fact, Obama said “Christmas” eight times, twice as often as he mentioned “holidays.” With his family at his side, the president also used an even more controversial word — “Christian.”

“Each year we’ve come together to celebrate a story that has endured for two millennia,” he said. “It’s a story that’s dear to Michelle and me as Christians, but it’s a message that’s universal: A child was born far from home to spread a simple message of love and redemption to every human being around the world.”

Politicos did the Beltway math and got this number — 2012.

God talk is back in the political equation, as the clock ticks toward another campaign. Insiders are counting how often Obama clearly mentions his Christian faith and then subtracting, to cite a key statistic, the number of times he quotes the Declaration of Independence while clipping God from the line that “all men are created equal, that they are endowed by their Creator with certain unalienable Rights.”

Many pastors seem to be paying attention as well, according to a recent LifeWay Research survey that asked 1,000 Protestant pastors to judge the faith of five public figures. Researchers interviewed a spectrum of clergy, with the selection of participants based on the sizes of their national denominations. Thus, conservative flocks had more votes.

The question: “Which, if any, of the following people do you believe are Christians?” It was thumbs up for former President George W. Bush (75 percent) and GOP lightning rod Sarah Palin (66 percent), but thumbs down for Obama (41 percent), as well as media superstars Glenn Beck (27 percent) and Oprah Winfrey (19 percent).

Among the pastors who said they were Republicans, 23 percent said Obama is a Christian, a stark contrast with the 80 percent of the pastors who identified themselves as Democrats. Among “independents,” 52 percent called Obama a Christian.

Bush was viewed as a Christian by 75 percent of the pastors, including 84 percent of those who identified their politics as “liberal” or “very liberal.” Meanwhile, 25 percent of the “very conservative” Protestant clergy declined to call Bush a Christian.

One thing this survey made clear is that many American clergy have clashing definitions of the word “Christian,” said Ed Stetzer, president of LifeWay Research, which is linked to the 16 million-member Southern Baptist Convention.

For many Americans, he said, “Christian” is “simply an identification on a form. They see a box on a survey and they say, ‘I am not Hindu or Jewish. I am from America, so I must be Christian.’ … Pastors may see this differently. For example, evangelical pastors tend to link the term ‘Christian’ with conversion experiences.”

Thus, conservative Protestants believe that people are not born into Christianity, but enter the faith by being “born again.”

This is why the Obama controversies are so hard to understand, stressed Stetzer. On several occasions — including in his memoirs — Obama has described what is “clearly a conversion experience of some kind” in which he made a public profession of Christian faith and joined the United Church of Christ.

Nevertheless, Obama supporters were stunned by last year’s much-publicized Pew Research Center poll that said 18 percent of Americans continue to believe that Obama is a Muslim, while only 34 percent identify him as a Christian. Another 43 percent did not know his religious faith.

There is no way to be sure why so many of the clergy who participated in the LifeWay survey declined to call Obama a Christian, stressed Stetzer.

A few may think he is a Muslim, while others may believe that Obama is so progressive that he is trying to affirm multiple faiths at the same time. It is likely that many conservatives believe that Obama sincerely thinks he is a Christian, but that his religious beliefs are too unorthodox to be considered doctrinally sound.

“I just don’t think that the Muslim controversy alone is enough to explain what we’re seeing here,” said Stetzer. “At the end of the day, we only know that the pastors answered this way, not why they answered this way. We have more work to do on this.”

The First Family walked across Lafayette Square Park to St. John’s Episcopal Church, a parish so close to the White House that many call it the “Church of the Presidents.” The Obamas set down front and received Holy Communion.

Was this really an important news story?

Timing was everything. The Obama family had not occupied a public pew — as opposed to attending services at Camp David — since Easter. And this church visit came shortly after a Pew Research Center poll found that 18 percent of Americans insist on believing that Obama is a Muslim, a stunning number that was up from 11 percent in March 2009.

Obama has, in numerous speeches and his two memoirs, offered detailed testimonies about his progressive faith and why he feels at home in the United Church of Christ, a freewheeling flock that has long helped define the left wing of Protestantism. Nevertheless, only 34 percent of Pew poll participants said the president is a Christian and a stunning 43 percent could not identify his current religion. Only 46 percent of Democrats, and 43 percent of African-Americans, said Obama is a Christian.

Like it or not, 2010 was that kind of year.

One Baptist progressive was blunt. While the president must continue to defend the “American principle of religious freedom for all, including Muslims and non-believers,” it wouldn’t hurt for Obama to join a local church, said the Rev. J. Brent Walker, executive director of the Baptist Joint Committee.

“His recent Democratic predecessors did just that,” noted Walker. “The public remembers pictures of President Clinton leaving Foundry Memorial United Methodist Church with Bible in hand during his presidency. President Carter taught Sunday school at First Baptist Church of the City of Washington, D.C. … President Obama should not do this simply for show; but an active, visible practice of his Christianity would help counter misunderstandings and lies about his faith.”

It was that kind of year, with many of the most vital news stories and trends rooted in confusing clashes about religious liberty, law, history and tradition.

Debates about Obama’s faith didn’t top the Religion Newswriters Association list of the year’s top stories, after figuring so prominently in 2008 and 2009. However, this year’s No. 1 story — fierce debates nationwide about a planned mosque and community center near New York’s Ground Zero — once again forced the president out onto a painfully familiar religious tightrope. The White House even became involved in efforts to convince an obscure Florida pastor to cancel his “International Burn a Koran Day” media event on, of course, Sept. 11.

Indeed, it was that kind of year. Here’s the rest of the RNA top 10.

(2) The catastrophic earthquake in Haiti sparks relief efforts by many different kinds of faith-based groups. An independent group of Baptists from Idaho spends some time in a Haitian jail after accusations of child smuggling.

(3) Pope Benedict XVI is accused of helping to delay actions against pedophile priests in Ireland, Germany, the United States and other countries while, as a cardinal, he led a key Vatican office between 1981 and 2005. Several bishops resign.

(4) The Tea Party — Religious Right believers or talk-radio fans attacking government spending? Mormon Glenn Beck pushes both buttons on the National Mall.

(5) The nation’s Catholic bishops oppose the White House health-care reform bill, in yet another clash over public funding for abortion. The bill passes, with strong support from many liberal Catholics and other religious progressives.

(6) The General Assembly of the Presbyterian Church (U.S.A.) votes — for the fourth time — to ordain noncelibate gay clergy. Once again, regional presbyteries still have the option to say “no.”

(7) Hard times force cuts in many religious headquarters, from the long-suffering world of old-line Protestantism to conservative groups, such as Focus on the Family.

(8) Religious groups debate whether links exist between traditional forms of many faiths and the suicides of gay young people who have been bullied by peers.

(9) The Pew Forum’s U.S. Religious Knowledge Survey finds that people with intense views about religion — whether pro or con — know the most correct answers.

(10) The U.S. Supreme Court convenes for the first time ever without a Protestant justice in its ranks — with six Catholics and three Jews.

Obama proceeded to recite the opening lines of the Muslim call to prayer in Arabic, with what Nicholas D. Kristof called a “first-rate accent.” Obama described this chant as “one of the prettiest sounds on Earth at sunset.”

This text, in one English translation, proclaims: “Allah is Supreme! Allah is Supreme! … I testify that there is no god but Allah! … I testify that Muhammad is the messenger of Allah.” These lines are known as the Shahada — from the Arabic verb, “to testify” — and reciting them, in public, with the intent of becoming a Muslim, is a crucial act in entering and then practicing the faith.

This is the kind of biographical detail that keeps complicating matters for journalists who try to make sense of the poll from the Pew Research Center and the Pew Forum on Religion & Public Life indicating that 18 percent of Americans think Obama is a Muslim, as opposed to 11 percent in March 2009.

Only 34 percent of those polled said Obama is a Christian and a stunning 43 percent did not know his current religion. Among his strongest supporters, 43 percent of blacks and 46 percent of Democrats said he is a Christian.

These numbers are strange in light of Obama’s public testimonies about his conversion to Christianity, after years of spiritual struggle.

In his memoir, “The Audacity of Hope,” Obama confessed that as a young social activist he realized, “Rich, poor, sinner, saved, you needed to embrace Christ precisely because you had sins to wash away — because you were human. … I was finally able to walk down the aisle of Trinity United Church of Christ one day and be baptized. … Kneeling beneath that cross on the South Side of Chicago, I felt God’s spirit beckoning me. I submitted myself to His will, and dedicated myself to discovering His truth.”

This was an open confession of faith, even if many conservative Christians choose to reject the liberal beliefs he has articulated through the years. During the campaign, the Rev. Franklin Graham asked Obama if Jesus was the only way to heaven. “Jesus is the only way for me,” he responded.

Meanwhile, the Obama team has had difficulty communicating a clear message about his faith history. Campaign aides, at first, said he had never been a Muslim, but later stressed that he had never been “a practicing Muslim.”

Obama’s family history is hard to describe. His father was a Muslim from Kenya who became an atheist. His stepfather was a Muslim who, in Obama’s words, was raised in an era in which Indonesia offered a tolerant approach to Islam that blended with “remnants of Hinduism, Buddhism, and ancient animist traditions.” His mother was raised as a Christian, but adopted her own mix of secularism and spirituality.

While in Indonesia, Obama attended what he has called a “Muslim” public school and also a Catholic school. At both schools, according to educators interviewed by the Los Angeles Times, his faith was listed as “Muslim.” School friends recalled that they often went to the mosque together.

Nevertheless, there is no single, definitive Islamic approach to questions about the role of birth and upbringing in establishing a person’s religious identity.

Franklin Graham was only partially right when he told CNN: “The president’s problem is that he was born a Muslim. His father was a Muslim. The seed of Islam is passed through the father. … His father gave him an Islamic name.” Graham added that Obama has “renounced Islam and he has accepted Jesus Christ. That’s what he says he has done. I cannot say that he hasn’t.”

This view of Islamic tradition is much too simplistic, said Stephen Prothero of Boston University, author of “God is Not One: The Eight Rival Religions that Run the World.” There is more to this debate about faith and identity than DNA, he stressed.

“As a matter of jurisprudence, however, there is a presumption that a child born to a Muslim father is Muslim,” said Prothero, in an email exchange. “This needs to be followed up with ACTION, however. …

“Like Christianity, Islam is a matter of choice, not inheritance.”

Under the headline “Super Bowl Censorship,” it defended the Christian group’s right to buy a prime chunk of airtime, even if the ad focused on the decision by an ailing Pam Tebow to ignore her doctors’ advice to abort her fifth child — a son named Tim. Protests by the National Organization for Women, NARAL Pro-Choice America and others, it said, were “puzzling and dismaying.”

“The would-be censors are on the wrong track,” proclaimed the Times. “Instead of trying to silence an opponent, advocates for allowing women to make their own decisions about whether to have a child should be using the Super Bowl spotlight to convey what their movement is all about. … Viewers can watch and judge for themselves. Or they can get up from the couch and get a sandwich.”

Where should Focus on the Family President Jim Daly place this memento? After all, it represents a major event during the final days of founder Dr. James Dobson, the child psychologist who over three decades built one of America’s most powerful radio franchises and evangelical ministries. Dobson’s farewell broadcast was Feb. 26th.

Daly, who became Focus on the Family president in 2005, is thinking about putting the framed editorial between two photos. In one, Daly is standing with President George W. Bush. In the other, he is standing with President Barack Obama.

“I’ll find a spot,” he said. “That would be a rather symbolic place to put it.”

Daly has worked for Focus on the Family for two decades, focusing on building a global audience of 200 million listeners. He is well aware that some loyalists on the legendary Focus on the Family mailing list — a major resource when raising money or inspiring grassroots support on hot issues — are worried about recent strategic moves.

Take, for example, Daly’s decision to attend an Obama White House conference on fatherhood. Some also questioned the decision not to fight CBS over the right to explicitly mention abortion in the Super Bowl ad.

“I don’t want to underestimate their concerns,” said Daly. “There are people who want to see more of the hard-hitting approach. The thing is, I’m not sure that approach still works today.”

While it’s impossible to say if Focus on the Family will take another Super Bowl plunge, the mainstream-media approach used in the Tebow family ad is a sign to what lies ahead, and not just because the Heisman Trophy winner will soon be playing in nearby Denver.

The goal all along was to use the brief advertisement to point viewers toward a longer version of the Tebow story at FocusOnTheFamily.com, said spokesman Gary Schneeberger. Thus, the crucial post-Super Bowl numbers were these — 92 million of the 106 million who watched the game told researchers they saw the Tebow ad. Among those who did, 6 percent said the spot and the furor surrounding it made them think twice about their beliefs on abortion. In all, about 1.5 million people went online to watch the more detailed Tebow feature.

Daly and Schneeberger insisted that there was no sneaky, brilliant strategy to hide the ad’s contents, other than their desire to keep pressure off Tebow as he prepared for his final college bowl game. Nevertheless, a giant media storm was triggered by an early report that Focus on the Family was planning a Super Bowl ad, coupled with a later wire-service story that the Tebows were involved. The result, said Schneeberger, was the equivalent of $32 million worth of free ink and airtime in national media.

“The people who didn’t approve of the ad that they had never seen ended up doing all of our talking points for us,” he said. “We didn’t have to say anything else.”

The key lesson, agreed Daly, was that it’s possible to “reach out and hold a dialogue” with an audience larger than the Focus on the Family mailing list. The Super Bowl project proved that the ministry could frame a message in such a way that “people outside of our niche had a chance to catch it and it does appear that some caught it. We think that’s progress.”

Both men quoted the Psalms. Both concluded with visions of eternal life and heavenly reunions. Both referred to familiar songs that offered comfort.

Facing those gathered in Beckley, W.Va., to mourn the loss of 29 miners, President Barack Obama asked them to remember a rhythm and blues classic — “Lean on Me” — that had its roots in coal country life.

Songwriter Bill Withers wrote: “Sometimes in our lives, we all have pain, we all have sorrow. … Lean on me, when you’re not strong and I’ll be your friend. I’ll help you carry on, for it won’t be long ‘til I’m gonna need somebody to lean on.”

The Rev. Billy Graham was more daring at the 1995 prayer service for the 168 victims of the bombing at the Alfred P. Murrah Federal Building in Oklahoma City. The world’s most famous evangelist even quoted an explicitly Christian hymn.

“The soul that on Jesus hath leaned for repose I will not, I will not desert to its foes,” claims “How Firm a Foundation,” in its final verse. “That soul, though all hell should endeavor to shake, I’ll never, no, never, no, never forsake!”

There is no way to know if Obama and Graham talked about heaven, hell and eulogies when they held their first face-to-face meeting, just a few hours before the president traveled to West Virginia.

Reporters were not allowed to witness the 30-minute session, the kind of confidential meeting that Graham has held with every president since Harry Truman. Obama was the first to meet with the evangelical statesman at his log home on a mountainside above Montreat, N.C.

Graham’s career has been defined as much by these moments of civil religion as by the decades of crusades in which he preached to millions. Deputy Press Secretary Bill Burton told reporters that Graham is a “treasure to our country” and that, while the 91-year-old preacher has “some of the creaks that come with advancing age,” he remains as “sharp as he ever was.”

Some details of the meeting were relayed to the Associated Press by the Rev. Franklin Graham, the outspoken heir to his father’s ministry. Billy Graham gave Obama two Bibles, one for him and one for First Lady Michelle Obama. The evangelist prayed for America and for wisdom for the president. Obama offered a prayer thanking God for Graham’s life and ministry.

Franklin Graham’s presence guaranteed the discussion of at least one sensitive subject, since the Army recently rescinded his invitation to speak at a Pentagon prayer service. After the Sept. 11 attacks, the younger Graham called Islam an “evil and wicked religion” and he still insists that Muslims need to know that Jesus died for their sins.

When they discussed the Pentagon’s approach to religion, Franklin Graham said that Obama promised “he would look into it.”

That’s the kind of theological terrain that presidents strive to avoid. Thus, Obama remained safely vague when using God language in West Virginia. If there is comfort in the wake of the mine tragedy, he said, “it can, perhaps, be found by seeking the face of God, who quiets our troubled minds, a God who mends our broken hearts, a God who eases our mourning souls.”

Obama concluded with an appeal for safer mines, blending spiritual concerns into the politics of rock and coal.

“We cannot bring back the 29 men we lost. They are with the Lord now,” he said. “Our task, here on Earth, is to save lives from being lost in another such tragedy; to do what must do, individually and collectively, to assure safe conditions underground. … We have to lean on one another, and look out for one another, and love one another, and pray for one another.”

In Oklahoma City, Graham had closed with an openly evangelistic appeal, the kind of spiritual warning he has urgently voiced for decades.

“This event,” he said, “reminds us of the brevity and uncertainty of life. It reminds us that we never know when we are going to be taken. I doubt if even one of those who went to that building to work or to go to the children’s place ever dreamed that that was their last day on earth. That is why we each need to face our own spiritual need and commit ourselves to God.”

That’s true in the current debates about health care, poverty and even gay marriage, he said, at the recent National Prayer Breakfast.

“Surely we can agree to find common ground when possible, parting ways when necessary,” said Obama. “But in doing so, let us be guided by our faith and by prayer. For while prayer can buck us up when we are down, keep us calm in a storm, while prayer can stiffen our spines to surmount an obstacle — and I assure you I’m praying a lot these days — prayer can also do something else. It can touch our hearts with humility. …

“Through faith, but not through faith alone, we can unite people to serve the common good.”

But while the president preached unity, this year’s National Prayer Breakfast was surrounded by controversy. There were signs this event on the semi-official Washington, D.C., calendar may no longer be able to serve as a safe forum in which a wide variety of religious and political leaders can unite their voices. The breakfasts began in 1953 and every president since Dwight Eisenhower has taken part.

Before the event, the leaders of the watchdog group Citizens for Responsibility and Ethics in Washington sent a letter to the White House and to Congressional leaders calling for a boycott. They also urged C-Span not to televise the breakfast. Meanwhile, a coalition of gay-rights activists and religious liberals announced a series of alternative “American Prayer Hour” events in Washington and other cities nationwide.

Both groups focused intense criticism on The Fellowship, the nondenominational Christian organization that sponsors the prayer breakfast and similar networking events in Washington and around the world. The key is that numerous Ugandan leaders are active in Fellowship activities in that country, including the politician who introduced anti-gay legislation that includes capital punishment for some offenses.

The ethics group’s letter accused this organization — often called “The Family” — of being a “cult-like secret society with unknown motivations and backing” that preaches an “unconventional brand of Christianity focusing on meeting Jesus ‘man-to-man.’ ” The American Prayer Hour coalition simply called it a “secretive fundamentalist organization.” The New York Times noted that the group has no “identifiable Internet site, no office number and no official spokesman.”

However, some religious conservatives have also expressed doubts about The Fellowship. In an investigation of its property holdings in and around Washington, World magazine called attention to The Fellowship’s “muddy theology,” its “distain for the established church” and an emphasis on privacy that “grew into an obsessive culture of secrecy.”

Describing the participants in Fellowship events, Republican Sen. James Inhofe of Oklahoma told World: “Some of them are Muslims. Some of them are Christians. But they meet in the spirit of Jesus, so it’s not a denominational thing, it’s not even a Christian thing, it’s a Jesus thing.”

The ultimate issue is that this organization needs to admit that it exists and talk openly about its activities and goals, said journalist Jeff Sharlet, author of “The Family: The Secret Fundamentalism at the Heart of American Power.” It’s a sign of progress, for example, that many Americans who are active in the organization have rejected the Ugandan legislation and communicated their dismay to their contacts in Uganda.

When it comes to the National Prayer Breakfast, the Fellowship’s leaders “should go completely public,” said Sharlet, by email. They should “acknowledge their existence, the fact that this is their event, make their account of it accountable (it was not Ike’s idea), explain the process by which people are invited and … make explicit that this is about consecrating leadership to Jesus. Everybody is welcome, but it’s about Jesus.”

This kind of transparency might accelerate what already seems to be happening. Some leaders — on the left and right — might reject the big-tent approach offered by the National Prayer Breakfast and create their own events, which could focus on more explicit messages about faith and politics.

If the Fellowship’s leaders are truly “serious about what they’re about,” noted Sharlet, this “would be great by their lights. They would lose a lot of clout, but the prayer breakfast movement would at last become an actual movement, of many strands.”

Consider, for example, this reference to health care in its chapter on the biblical instruction, “You shall love your neighbor as yourself.”

“Life and physical health are precious gifts entrusted to us by God,” notes the catechism. “Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment and social assistance.”

The implication is that governments — as a matter of social justice — should help citizens obtain basic health care, according to a letter sent to Congress and the White House by the Domestic Justice and Human Development Committee of the U.S. Conference of Catholic Bishops.

Health care is a human right, not a privilege, argued Bishop William F. Murphy.

“All people need and should have access to comprehensive, quality health care that they can afford, and it should not depend on their stage of life, where or whether they or their parents work, how much they earn, where they live, or where they were born,” wrote Murphy.

But there’s a problem. The letter stresses that the church will support accessible, affordable, universal health-care reform if it “protects and respects the life and dignity of all people from conception until natural death.”

Try telling that to Health and Human Services Secretary Kathleen Sibelius, Speaker of the House Nancy Pelosi, surgeon general nominee Regina Benjamin, Vice President Joe Biden and other Catholics who play strategic roles in Washington, D.C., right now — while rejecting Catholic teachings on many critical health-care issues.

That’s the political reality that the bishops are facing, said Leonard J. Nelson III, a health-care law specialist at the Cumberland School of Law at Samford University.

For the bishops, Catholic teachings on the sanctity of human life are crystal clear, from birth to death, from abortion to euthanasia. Yet the bishops also support health-care for all — rich and poor. It’s getting harder and harder to keep these issues woven together.

“The bishops have been talking about social justice and health care for years and years and now the political climate has changed around them,” said Nelson, author of the new book, “Diagnosis Critical: The Urgent Threats Confronting Catholic Health Care.”

“The politicians who are in command are ready to pass some kind of health-care reform and they have all kinds of reasons to include abortion in that package. … That’s the fix that the bishops are in.”

Meanwhile, he said, leaders of Catholic hospitals and health-care systems will almost certainly face challenges in the near future.

For starters, they could be pressured to join networks and cooperatives that have no reason to follow the bioethical guidelines detailed in the “Ethical and Religious Directives for Catholic Health Care Services” adopted by the U.S. Catholic bishops. It will be hard for Catholic leaders to cooperate with government approved health-care programs and receive government funds while declining to offer services such as contraception, sterilizations and referrals for abortions.

Catholic leaders also know that another life-and-death issue looms in the background. As President Barack Obama noted in a recent New York Times interview, it’s impossible to cut or control costs without government efforts to shape health care in the final years of life.

“That’s where I think you just get into some very difficult moral issues,” said Obama. “But that’s also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.”

The Catholic bishops, noted Nelson, have not addressed these end-of-life scenarios — yet. Will government agencies or advisory boards be given the power to decide whether patients facing Alzheimer’s or Parkinson’s disease receive expensive medications? Who will decide whether elderly patients have a high enough “quality of life” to continue receiving medical care?

“Productive people in the middle years of life are always going to get the health care they need,” said Nelson. “The big threats to the sanctity of life come at the very beginning and at the end. If you’re going to defend the church’s teachings on health care, you have to focus on those threats. The bishops have to find a way to do that.”

That wasn’t the kind of reassurance Dodd wanted, as a University of Notre Dame senior weeks away from her graduation ceremonies. When she returned to campus, Dodd headed straight to Notre Dame’s grotto — a small cave modeled after the famous Marian shrine in Lourdes, France.

“I knew this: No amount of shame or embarrassment would ever lead me to get rid of my baby. Of all women, Our Lady could surely feel pity for an unplanned pregnancy,” wrote Dodd, in an essay aimed at Father John Jenkins, the university’s president. The text was posted online by the journal First Things.

“In my hour of need, on my knees, I asked Mary for courage and strength. And she did not disappoint,” she added. “My boyfriend was a different story. He was also a Notre Dame senior. When I told him that he was to be a father, he tried to pressure me into having an abortion. … ‘All that talk about abortion is just dining-room talk,’ he said.”

Family and friends stood by Dodd’s side. Today, a decade later, she is a single mother and her daughter’s name is Mary. Dodd serves on the board of Room at the Inn, an organization working to build an on-campus facility for pregnant unwed students at Belmont Abbey College, near Charlotte, N.C.

The timing of Dodd’s essay — “Notre Dame, My Mother” — is, of course, linked to her alma mater’s decision to invite President Barack Obama to deliver its mid-May commencement address and to receive an honorary doctor of laws degree.

Throughout his political career, Obama has opposed all restrictions on abortion rights, even in late-term procedures. But he has also reached out to Catholic and evangelical voters by pledging to help lessen the need for abortions, through government efforts to aid needy mothers and their children.

Catholic traditionalists and many Notre Dame alumni argue that honoring Obama in this way violates a 2004 U.S. Conference of Catholic Bishops policy that said: “The Catholic community and Catholic institutions should not honor those who act in defiance of our fundamental moral principles. They should not be given awards, honors or platforms which would suggest support for their actions.”

Three years later, the bishops underlined the importance of this issue, arguing that the “direct and intentional destruction of innocent human life is always wrong and is not just one issue among many.”

However, a recent online count found that only 66 bishops, out of 195 dioceses nationwide, have issued public comments critical of Notre Dame’s decision. So far, the Vatican has remained silent on the issue.

Meanwhile, a Pew Forum on Religion & Public Life poll found that 50 percent of American Catholics approve of Notre Dame’s decision to “invite” Obama, while 28 percent disapprove. However, only 37 percent of white, non-Hispanic Catholics who attend Mass weekly agreed with the Notre Dame decision, compared with 56 percent of those less active in the church. This parallels that fact that 61 percent of these “attend less often” Catholics support abortion rights in all or most cases, as opposed to 30 percent of the “attend weekly” Catholics.

Alumni and current students know that these kinds of divisions also exist at Notre Dame, said Dodd. Notre Dame students also face crisis pregnancies and some young women there are convinced that they must have abortions in order to stay in school.

While others focus on the political implications of honoring Obama, Dodd said she worries about the impact of this symbolic event on women in the commencement audience who are wrestling with the same secret she faced 10 years ago.

Thus, she ended her essay with this question to the priest who currently leads Notre Dame: “Who draws support from your decision to honor President Obama — the young, pregnant Notre Dame woman sitting in that graduating class who wants desperately to keep her baby, or the Notre Dame man who believes that the Catholic teaching on the intrinsic evil of abortion is just dining-room talk?”

These kinds of influences make a difference, said Dodd.

“I think that Notre Dame needs to be in the lead when it comes to supporting women who face unplanned pregnancies,” she said. “Notre Dame needs to be on their side — always.”

Consider this hypothetical landmine: Would it be discrimination for a Christian AIDS hospice to refuse to hire a worker who believes AIDS is a sign of God’s wrath?

Ponder these scenarios. Can a Muslim school fire a teacher who converts to Christianity? Can a Jewish pre-school discriminate against a job applicant who is active in Jews for Jesus?

Wait, there’s more. Is it job discrimination for an evangelical shelter for parents and children to refuse to hire someone who rejects centuries of Christian teachings on sex and marriage? How about forcing a Catholic hospital to hire doctors and nurses who reject the church’s doctrines on abortion?

These are the kinds of questions swirling around the White House as Obama tries to find a way to embrace a wide variety of religious groups and the faith-based ministries they operate — while rejecting some of the ancient doctrines that guide their work.

“There is no doubt that the very nature of faith means that some of our beliefs will never be the same,” said Obama, at the National Prayer Breakfast in which he promoted his Office of Faith-Based and Community Initiatives. “We read from different texts. We follow different edicts. We subscribe to different accounts of how we came to be here and where we’re going next — and some subscribe to no faith at all.

“But no matter what we choose to believe, let us remember that there is no religion whose central tenet is hate. There is no God who condones taking the life of an innocent human being.”

Then, citing a variety of faith traditions, he said one law can bring unity, which is “the Golden Rule — the call to love one another; to understand one another; to treat with dignity and respect those with whom we share a brief moment on this Earth.”

The audience said, “amen.” But church-state lawyers and packs of social activists began murmuring about the details. There are, after all, secular and religious groups that believe President George W. Bush’s team erred when it allowed many faith-based ministries to receive government funds, while hiring only employees who affirmed their doctrines and mission statements.

These tensions remain, because Obama has decided — for now — to allow this practice to continue, while stressing that the Justice Department will review complaints on a case-by-case basis.

The ground is moving. For decades, a guiding principle of church-state law has been that state officials must avoid becoming “entangled” in doctrinal questions that allow the government to favor some faith groups over others.

In his prayer breakfast speech, the president said his initiative would not “favor one religious group over another — or even religious groups over secular groups.” But will some ministries get to hire according to their doctrines, while others will not, with the government separating the sheep from the goats?

“I really don’t have a clue” what the case-by-case language means, said Stanley Carlson-Thies, who worked with the Bush White House and now leads the Institutional Religious Freedom Alliance. “I think they are trying to get out of the fix they’re in. Obama’s people have told so many religious groups that they’re not going to hurt what they do. Yet they have also told groups on the other side, ‘Of course we stand with you. This is discrimination and we’re not going to allow it.’ “

As recently as the 1990s a broad coalition of church-state experts — from the American Civil Liberties Union to the Christian Coalition — managed to work together on some crucial religious liberty issues. The goal was to promote free speech, freedom of association and “equal access” for believers and nonbelievers in the public square.

But today, driven by conflicts over gay rights, the spotlight is on what candidate Obama consistently called “religious discrimination.” The White House must choose between armies of religious believers who follow radically different sets of doctrines.

In the end, it’s impossible to separate the power of faith from the doctrines and traditions that inspire these believers, said Carlson-Thies.

“The faith is where the passion comes from, it’s where the witness is,” he said. “It’s clear that the president admires many of these faith groups and the work they do. The question he faces now is, ‘Do you want to work with them or not?’ “