Archbishop Salvatore Joseph Cordileone leads the Archdiocese of San Francisco, a symbolic city in debates about modern American culture.

But what matters the most, as tensions rise among Catholic leaders, is that Cordileone is House Speaker Nancy Pelosi's hometown bishop. Thus, it's hard for politicos to avoid blunt passages in his new pastoral letter, "Before I Formed You in the Womb I Knew You."

Citing centuries of church doctrine, the archbishop argued that Catholics who "reject the teaching of the Church on the sanctity of human life and those who do not seek to live in accordance with that teaching should not receive the Eucharist. It is fundamentally a question of integrity: to receive the Blessed Sacrament in the Catholic liturgy is to espouse publicly the faith and moral teachings of the Catholic Church, and to desire to live accordingly."

There is, he added, "a great difference between struggling to live according to the teachings of the Church and rejecting those teachings. … In the case of public figures who profess to be Catholic and promote abortion, we are not dealing with a sin committed in human weakness or a moral lapse: this is a matter of persistent, obdurate and public rejection of Catholic teaching. This adds an even greater responsibility to the role of the Church's pastors in caring for the salvation of souls."

Citing a famous example, Cordileone recalled when former New York Mayor Rudolph Giuliani received Holy Communion during a 2008 Mass led by Pope Benedict XVI. This caused scandal and, according to the late Cardinal Edward Egan, violated an agreement that Giuliani would not receive the Sacrament because of his public support for abortion rights and other clashes with doctrine.

The big issue, as U.S. bishops prepare for June discussions of "Eucharistic coherence," is not how to handle a former New York City mayor. The question is whether bishops can address their own divisions about the status of pro-abortion-rights Catholics such as Pelosi and President Joe Biden. While vice president, Biden also performed two same-sex marriage rites.

San Diego Bishop Robert McElroy, firing back at Cordileone in America magazine, stressed that the "Eucharist must never be instrumentalized for a political end. … But that is precisely what is being done in the effort to exclude Catholic political leaders who oppose the church's teaching on abortion and civil law. The Eucharist is being weaponized and deployed as a tool in political warfare. This must not happen."

Meanwhile, the prefect of the Vatican's Congregation for the Doctrine of the Faith warned the leader of the U.S. Conference of Catholic Bishops that these issues could become a "source of discord rather than unity within the episcopate" and among all American Catholics.

Writing to Los Angeles Archbishop Jose Gomez, Cardinal Luis F. Ladaria said it's important to focus on the "broad context of worthiness for the reception of holy Communion on the part of all the faithful," not just politicians. The Jesuit's leaked letter has been discussed in America magazine, The Pillar, National Catholic Register and elsewhere.

The bottom line, said Ladaria, is that any effective "policy in this area requires that dialogue occurs in two stages: first among the bishops themselves, and then between bishops and Catholic pro-choice politicians within their jurisdictions."

Thus, a key figure in this drama will be the new leader of Biden's home diocese in Delaware. In his introductory press conference, Bishop-elect William Koenig told reporters he prays for Biden "every day" and would "certainly be open to having a conversation in the future. … As a bishop, I'm called to teach the fullness and the beauty of the Catholic faith."

As for Cordileone, he stressed that many Catholics fail to grasp how defending unborn life -- "a moral absolute" -- is linked to discussions of immigration, economic justice, the environment and other examples of what Pope Francis calls "throw-away culture."

Rejecting these life-and-death truths, said Cordileone, will have eternal consequences.

"When public figures identify themselves as Catholics and yet actively oppose one of the most fundamental doctrines of the Church … we pastors have a responsibility both to them and to the rest of our people. Our responsibility to them is to call them to conversion and to warn them that if they do not amend their lives they must answer before the tribunal of God."