In Catholic debates, it always helps to be able to quote the official Catechism of the Catholic Church. 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."