Who’s running your local hospital?

There’s been an ongoing — and frightening — trend in health care circles: Catholic organizations are merging with secular hospitals and health-care providers, striking agreements that include strict adherence to Catholic teaching. The implications for patient care can be very serious, especially if you’re a woman or an elderly person… but many people don’t know about the possible ramifications until it’s too late.

According to the most recent numbers from the Catholic Health Association of the United States of America (CHAUSA), one-sixth of Americans admitted to hospitals across the country are getting care from Catholic organizations. In some cases, that may not matter. In other situations, it could mean the difference between life and death.

That’s because Catholic hospitals often put policies into place that privilege the Church’s dogma over patients’ freedom of conscience and choice… and, in some cases, health. Doctors, nurses, and other caregivers in a Catholic hospital may find themselves prohibited (PDF) by the institution that employs them from offering patients the best-quality care. According to Sheila Reynertson, advocacy coordinator for MergerWatch (via email):

Mergers between secular and Catholic health care facilities always result in the adoption of some or all of the Ethical and Religious Directives, depending on the nature of the contract and the bishop’s willingness to compromise.

It’s probably not surprising that the most egregious violations come up in areas related to reproductive health. Catholic hospitals, almost without exception, refuse to offer abortion, contraception (emergency or otherwise), vasectomies, tubal ligations, or reproductive-health services like in-vitro fertilization.

In serious medical cases where pregnancy threatens the woman’s life, doctors are required to either send a woman off-site for her abortion or attempt to save both lives, even when the woman’s chances could be clearly and dramatically improved by terminating the pregnancy. In the case of ectopic pregnancy, a potentially fatal condition where the embryo is stuck in the Fallopian tube, Catholic medical ethics only permit the removal of the entire blocked tube, decreasing the woman’s future fertility by half. Doctors could extract the embryo without harming the tube, but that would defy Catholic moral teaching by causing an abortion directly. Removing the whole tube preserves an illusion of moral acceptability at the patient’s expense.

These moral contortions are being forced on doctors and patients who are not necessarily Catholic, oftentimes living in areas where they may not have access to alternatives. Poor women, who are more likely to rely on hospitals and hospital outpatient programs to meet their reproductive health needs, are disproportionately affected. And in an environment where Catholic organizations buy or merge with existing service providers with stunning regularity, staff and patients may find their health-care environment transformed suddenly and unexpectedly, forcing them into difficult situations.

Slightly less well known are the Catholic strictures on end-of-life care. Church dogma requires medical staff to provide certain life-support measures, like feeding tubes and intravenous hydration, indefinitely, even when the patient has given end-of-life directives in advance. In those cases, Catholic institutions will ignore the individual’s wishes if they conflict with Church teaching… even if the individual in question is not a Catholic. Given that, it’s troubling that Catholic organizations also own 1,400 long-term care and assisted living services and facilities, where their patients’ needs are subordinated to a doctrine they may not accept or understand.

It’s tempting to think that these situations are the Catholic Church’s efforts to undermine freedom of religion and impose their moral doctrines on the general population, but Reynertson says it’s really all about the bottom line:

“The days of nuns in habits running the hospitals are over. They are run by hospital administrators focusing on running a business, not spreading the word.”

In practical terms, though, the distinction means little for patients and care providers, who find themselves bound by the moral judgments of a religion they may not accept – and those judgments have real-world consequences. In 2009, two Texas health care providers agreed to refuse tubal ligations to women; a third hospital, in Oregon, refused to do the same and was stripped of its Catholic affiliation.

Sounds like good riddance! But for cash-strapped service providers, the withdrawal of Church funding is a serious concern. The Church has set up a system in which their networks of medical care enable them to negotiate better prices on insurance and medical equipment; being forcibly ejected from that system can upset a hospital’s budgetary balance in serious ways. Hospital staff often find themselves frustrated when the financial realities of hospital administration keep them bound to an institution that prioritizes dogma over what’s best for the patients.

MergerWatch is currently tracking possible Catholic/secular mergers in Arkansas, Texas, Maine, and Washington, among others. Defenders of the practice insist that a partnership with a Catholic-run organization is preferable to the full-scale loss of services.

Maybe so. But doctors and patients need some very strong legislation to protect them from religious organizations using their burgeoning wealth to impose a theological agenda on health care, even in cases where patients’ lives hang in the balance.

(Illustration by Bengie)



