When Medicine and Religion Collide

women's health

I find the following true story both appalling and scary. It is appalling because it should never have happened and it is scary because medical decisions were made, based not on the best medical knowledge available, but on religious doctrine. Here is the story.

A Michigan woman was eighteen weeks pregnant when her water broke. She visited a nearby Roman Catholic hospital twice and was sent home, each time in severe pain. Doctors at the hospital, directed by Roman Catholic guidelines that forbid abortion, did not tell her either that her fetus had virtually no chance of survival or that the safest treatment was to terminate the pregnancy.  On her third trip to the hospital, after she had begun to show signs of an infection, the hospital was preparing to send her home again when she miscarried.

While this experience occurred in Michigan, I have the uncomfortable feeling that this sort of scenario could just as easily occur at a hospital or a clinic near you or me. I suspect that most people have no idea that Roman Catholic beliefs are steering many of our health care options. Call me overly suspicious if you like, but I do not want the church – any church – in my bedroom or in my hospital room telling me what I can and cannot do.

But that is exactly what is happening. Let me explain.

All across the country, as the health care industry buckles under rising costs, many hospitals are partnering with one another in the hope that such mergers will help them survive and control costs. In some cases that means Roman Catholic health care organizations are acquiring secular hospitals or entering into affiliations and collaborations with non-Roman Catholic organizations. In at least eight states, more than 30 percent of all hospital care is Roman Catholic – and often subject to the directives of regional bishops.

At the heart of the matter for patients such as the woman mentioned above is a document called the “Ethical and Religious Directives (ERDs) for Catholic Health Care Services,” a directive that guides Roman Catholic providers. Written by the United States Council of Catholic Bishops in 2009, the ERDs forbid the following: abortions in any scenario except if the mother’s life is in danger, even in cases of rape or incest; access to contraceptives for the sole purpose of family planning; sterilization procedures; in vitro fertilization, or the use of sperm or egg donors; and assisting terminally ill patients seeking to terminate their lives.

The implementation of such directives could have profound implications for women’s access to reproductive services in hundreds of communities across the United States. Here is just one story: When Emily Herx first took time off work for in vitro fertilization treatment, her boss offered what sounded like words of support: “You are in my prayers.” Soon those words took on a more sinister meaning. The Indiana grade school where Herx was teaching English was Roman Catholic. And after church officials were alerted that Herx was undergoing IVF – making her, in the words of one monsignor, “a grave, immoral sinner” – it took them less than two weeks to fire her.

The kind of situation that I described above is occurring as more and more hospitals merge. The Affordable Care Act (commonly known as Obamacare) both encourages and facilitates hospital mergers. Many of these mergers involve Roman Catholic health systems as dominant partners. A joint study by the MergerWatch Project and the ACLU reports that ten of the nation’s largest hospital systems are Roman Catholic-sponsored. From 2001 to 2011, the study found, the number of beds in Roman Catholic hospitals rose by 13 percent, the largest such change of any category of hospitals, except the for-profit sector.

In Washington State, for example, which has seen more religious-secular partnerships than any other state in recent years, one quarter of all hospitals are Roman Catholic affiliated. The collision of medicine and doctrine reared its ugly head when in early 2012, Seattle’s Archbishop J. Peter Sartain instructed Saint Joseph Hospital to stop processing lab work for Planned Parenthood. The Planned Parenthood clinic relied on Saint Joseph for a few types of tests, including a series of blood tests drawn twenty-four hours apart to rule out ectopic pregnancy. Planned Parenthood pressured the hospital and the testing arrangement continued. Ultimately, Washington State policy makers, employers and voters are going to have to decide whether to continue supporting Roman Catholic health systems that systematically deprive patients of legal and medically appropriate care.

Roman Catholic control of the healthcare system could also have broader implications for healthcare professionals. Again, Seattle’s Archbishop Sartain and two other bishops hold power over all of Washington State’s Roman Catholic health care ministries, which now employ tens of thousands of people.  In a case now before Washington’s Supreme Court, Franciscan Hospital recently argued that Washington law exempts religious entities from State antidiscrimination laws.  If Franciscan wins that case, bishops could begin purging the health care system of anyone who refuses to adhere to Roman Catholic doctrine – even in their personal lives. That, of course, would include homosexuals and same-sex couples.

Continuing with Washington State a tad longer, I found that the secular Swedish Medical Center in Seattle was at the center of a controversial partnership with Roman Catholic-run Providence Health & Services in 2011. The Swedish Medical Center promised that it would remain secular, but shortly after the two facilities merged, Swedish announced that it would no longer offer elective abortions at its facilities and would instead donate money to a nearby Planned Parenthood facility. Critics say that is simply one of many examples of how Roman Catholic hospital mergers affect women’s health care. But reproductive rights advocates say that foregoing abortions may soon become a pre-requisite for secular hospitals when they join with their Roman Catholic counterparts.

Roman Catholic health systems also have pressured doctors with admitting privileges to stop helping terminally ill patients who want to make use of the state’s death with dignity law. Recently it was reported that Pope Francis denounced the death with dignity movement, saying it is a “false sense of compassion” to consider euthanasia as an act of dignity when in fact it is a sin against God and creation. Earlier, the Vatican’s top bioethics official condemned as “reprehensible” the assisted suicide of Brittany Maynard, the twenty-nine year old woman who was suffering terminal brain cancer and said she wanted to die with dignity and moved from California to Oregon because Oregon was one of only five states where death with dignity was authorized.

While denouncing euthanasia in general, the Pope also condemned abortion, in vitro fertilization, and embryonic stem cell research. So much for (“Who am I to judge”) Pope Francis being a Progressive Catholic!

UPDATE: Brittany Maynard’s mother is responding angrily to criticism from the Vatican of Maynard’s decision to end her life early under an Oregon law written to let terminally ill patients die on their own terms. Days after Maynard’s Nov. 1 death at age 29, the Vatican’s top bioethics official called her choice “reprehensible” and said physician-assisted suicide should be condemned.

I believe that all of this is sobering news for anyone concerned about the state of health care, and especially about the state of women’s healthcare. It is in the area of women’s healthcare where medical practice and Roman Catholic doctrine are most frequently in conflict. And it is happening as Roman Catholic hospitals are playing a more influential role in the American healthcare system.

None of this would matter, of course, if the Roman Catholic Church was not trying to impose its religious directives on the practice of medicine. But that is what it has been doing. In Bartlesville, Oklahoma, for example, doctors at a hospital acquired by a Roman Catholic health system were forbidden to prescribe any contraceptives, if they were to be used as birth control. (After the rule provoked a public outcry, it was rescinded.)

The MergerWatch/ACLU report and other sources document numerous instances of interference by religious prelates in medical decisions, especially those in which emergency terminations of pregnancies are indicated to save the mother.

In a recent meeting of the United States Conference of Catholic Bishops in Baltimore, the prelates voted almost unanimously – in a 213-2, with 1 abstaining vote – to review its policy on “forming new partnerships with health care organizations” to address a directive issued from the Vatican’s conservative Congregation for the Doctrine of Faith that, in essence, prohibits Roman Catholic hospitals from merging with secular hospitals that do not uphold the same values. The actual wording of the mandate is this: “[Roman] Catholic health care institutions neither cooperate immorally with the unacceptable procedures conducted in other health care entities with which they may be connected nor cause scandal as a result of their collaboration.”

That directive is bound to complicate merger deals, which are complicated enough already. Women’s clinics at some Roman Catholic-controlled hospitals have had to be designated secular zones, so physicians can practice without interference. Whether that would still be allowed under this new revision is not clear at this present time.

The bishops’ action may place new pressures on public officials with jurisdiction over such deals. Officials have not always met their obligations to the public interest when Roman Catholic hospitals take over non-Roman Catholic institutions. For instance, physicians and patients in California saw the process in action after Newport Beach’s Hoag Memorial Hospital Presbyterian, one of Orange County’s leading medical centers, merged with Saint Joseph Health System, a Roman Catholic chain. Despite being assured for months that nothing in their medical practice would change as a result of the deal, Hoag doctors were abruptly informed that abortions would henceforth be banned – a restriction imposed at Saint Joseph’s insistence. California Attorney General, Kamala D. Harris approved the Hoag/Saint Joseph merger, even after learning that the abortion ban would be imposed.

But a year later, when evidence emerged that Hoag and Saint Joseph officials might have misled Harris over the consequences of the deal, she redefined abortions so that not all such procedures would come under the ban. Harris made it clear that Hoag could not interfere with physicians performing procedures in their own offices, even if those offices were located on Hoag premises. Hoag’s commitment to maintaining women’s reproductive services at the same levels as before the merger was lengthened to twenty years from ten. And Hoag permanently committed itself not to be bound by the ERDs. I find that action a hopeful sign!

But Harris’ action does not fully remedy the damage that this merger did to women’s rights in California where abortions are, after all, legal. It is a sad truth that as a result of the merger, a woman’s ability to obtain a legal procedure in a leading hospital has been permanently eroded.

Many of the Roman Catholic hospitals merging with secular counterparts promise that the secular institutions will not be governed by Roman Catholic doctrine – although opponents of the mergers say that reproductive and other facilities thought to counter Roman Catholicism are often slowly phased out.

As more Roman Catholic health systems attempt to acquire secular hospitals, the threat to the unfettered practice of medicine increases and it will be up to public officials to monitor this trend and to stop it in its tracks. If they do not, I fear that women’s reproductive rights are in serious jeopardy.

So, women beware: the one who will decide what your health care will be may not be your physician or your insurance company. That health care decision most likely will be a Roman Catholic bishop! And, frankly, from everything that I have been able to learn about this subject, that scares the Hell out of me!

woman's health

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