The needless death of Savita Halappanavar last year, after a Catholic hospital refused to terminate her doomed pregnancy, drew a worldwide outpouring of fury against the religious dogmatism that killed her.

But as I wrote at the time, Savita’s story was only the tip of the iceberg. What happened to her wasn’t a fluke or an aberration: it was and is the official policy of the church that if a pregnant woman’s life can be saved by abortion, it’s better to let two die than to save one.

It’s only by a stroke of good fortune that we haven’t had any Savitas in the U.S. (that I’m aware of, at least). It’s certainly no thanks to the church hierarchy. And that makes it especially ominous that the Catholic hospital system is quietly expanding its reach across the U.S., merging with or gobbling up many of its secular counterparts:

“We are starting to see what was rare in the past,” said Lisa Goldstein, who follows nonprofit hospitals for Moody’s Investors Service and predicts more such partnerships… About one-sixth of all patients were admitted to a Catholic hospital in 2010. In many smaller communities, the only hospital within miles is Catholic. (source)

This is still going on today, as Americans United reported in a blog post from last month about Catholic entities seeking to take over public medical institutions in Texas and Kentucky. And when the church takes over, they’re not reluctant to throw their weight around: Irin Carmon reports on Salon that an astonishing 52% of OB-GYNs at Catholic hospitals have reported clashing with church-run ethics committees over the proper treatment of women with complications from pregnancy.

This is bad for men too, since it cuts off their access to procedures like sterilization that these hospitals no longer provide. But as always, the burden of religious oppression falls most heavily on women, since it’s only women who are denied access to literally lifesaving medical care by Catholic dogma (not to mention access to emergency contraception if they’re raped).

I regard this as a more serious problem than most other manifestations of the anti-choice movement. The noisy protesters who cluster outside reproductive health clinics can frighten and harass, but they can’t actually, legally, prevent anyone from getting an abortion there or otherwise making use of the clinic’s services. On the other hand, buying up hospitals does make it possible for religious zealots to cut off women’s access to legal, essential medical care.

There’s only one solution to this, and it has to be a legal one. Just as businesses that serve the public can’t discriminate by religion in whom they hire or whom they serve, so too should hospitals be forbidden to pick and choose which procedures they’ll offer or which medicines they’ll dispense based on the decrees of a religious authority.

We wouldn’t tolerate a Jehovah’s Witness-run hospital that forbade blood transfusions, even for people rushed into the emergency room dying of blood loss. We wouldn’t tolerate a Muslim-run hospital where doctors and nurses refused to wash their hands based on their interpretation of Islamic modesty laws. We wouldn’t tolerate an evangelical Christian-run hospital that turned gay people away at the door. Just the same way, we should refuse to tolerate a Catholic-run hospital where the imperial decrees of a bishop mean that a woman dying of sepsis or eclampsia can’t get a life-saving abortion as long as there’s any detectable fetal heartbeat.

It doesn’t matter exactly how we implement this – the “hospital within a hospital” created in one case in Austin seems like a reasonable compromise. But this is something we have to insist on. Religious individuals can decide what care they want for themselves based on their beliefs. But in a secular nation like America, it should be absolutely illegal for a religious authority to turn any part of the public square into a private fiefdom and exercise power over the lives of people who haven’t voluntarily agreed to abide by those rules.