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.