The spread of Catholic hospital systems has been a concern for some time. In 2011, the Sierra Vista Health Center called off a merger with a Catholic hospital system because they would then have to “abide by Catholic ethical and religious directives,” which would mean they could “no longer do abortions, even when the mother’s life is in danger, and they [could] no longer perform sterilizations or provide contraception.”

RH Reality Check reported on Mercy Hospital in Colorado, where “Chief Medical Officer Dr. John Boyd… [told cardiologist Dr. Michael] Demos in a meeting that he shouldn’t mention abortion at all to a patient, even if a pregnancy is a threat to a woman’s life.”

In May of 2013, The Daily Kos reported, “the rapid consolidation of smaller, rural and even teaching hospitals by expanding Catholic chains is putting women’s reproductive health—and sometimes their lives—at risk. Thanks to these mergers, acquisitions and strategic partnerships, decisions about contraception, abortion, sterilization and live-saving care aren’t being made by patients and their doctors, but by bishops.”

As Stephanie Mencimer explains in Mother Jones, Catholic hospital takeovers affect much more than just abortion:

Abortion services are always quick to go when a Catholic hospital takes over, but the changes go much further. In many cases, doctors are prohibited from prescribing birth control, and hospital pharmacies won’t sell it. Doctors may even be told not to counsel patients about it. Catholic hospitals have been reluctant to offer emergency contraception to rape victims, and when they do, they first require a pregnancy test to ensure the woman was not pregnant before the assault. The bishops’ guidelines forbid tubal ligations and vasectomies. They also extend to end-of-life care: Catholic hospitals may ignore patients’ requests to be removed from feeding tubes or life support, even if those wishes are expressed in living wills. And many states allow religious hospitals to discriminate against gays and lesbians, both as employees and as patients.

Mencimer notes that “Catholic hospitals are required to follow health care directives handed down by the US Conference of Catholic Bishops—a group of celibate older men who have become increasingly conservative over the past few decades.”

Now the ACLU is suing over Catholic hospitals’ health policies, and they aren’t suing the hospitals, they are suing the bishops.

The case was spearheaded by the case of a woman in Michigan, Tamesha Means. In 2010, 18 weeks into her pregnancy, her amniotic sac ruptured–normal during labor, but not good when it happens prematurely (it is called preterm premature rupture of membranes or PPROM). According to a New York Times story by Erik Eckholm,

Her fetus had virtually no chance of surviving, according to medical experts who reviewed the case, and in these circumstances doctors usually induce labor or surgically remove the fetus to reduce the mother’s chances of infection. But the doctors at Mercy Health, Ms. Means said, did not tell her that the fetus could not survive or that continuing her pregnancy was risky and did not admit her for observation. She returned the next morning, bleeding and in pain, and was sent home again. That night she went a third time, feverish and writhing with pain; she miscarried at the hospital and the fetus died soon after.

University of Wisconsin obstetrician Dr. Douglas W. Laube called it a case of “basic neglect.” In a report on National Public Radio by Julie Rovner, he said,

A woman who is 18 weeks pregnant and who presents with these symptoms, the same that Ms. Means had, should be told that there’s virtually no chance that her fetus will survive and that continuing the pregnancy puts her at risk, and that the safest course of treatment would be to terminate the pregnancy. From the outset, Ms. Means should have been given this information at the very least.

Richard Garnett, a law professor at Notre Dame, a Catholic University, responded to the news of the ACLU suit saying,

[T]o sort of claim that it is negligence for the bishops to be issuing directives reminding Catholic hospitals what the church’s teachings are with respect to things like abortion and sterilization are, that is a stretch. That seems to me to be adopting a strange notion of tort responsibility — that religious teachings become legal negligence.

But it’s not just a reminder–it’s a threat, as discovered by nun and Catholic hospital administrator Margaret McBride. Sister Margaret sat on an ethics committee that approved a first trimester abortion for a woman with a condition that made pregnancy life threatening. The Huffington Post reported the response of Bishop Thomas J. Olmsted, head of the Phoenix Diocese:

I am gravely concerned by the fact that an abortion was performed several months ago in a Catholic hospital in this diocese. I am further concerned by the hospital’s statement that the termination of a human life was necessary to treat the mother’s underlying medical condition. An unborn child is not a disease. While medical professionals should certainly try to save a pregnant mother’s life, the means by which they do it can never be by directly killing her unborn child. The end does not justify the means.

According to HuffPo, “Olmsted added that if a Catholic ‘formally cooperates’ in an abortion, he or she is automatically excommunicated,” which is exactly what happened to Sister Margaret, along with losing her job.

The ACLU reports on why the organization has taken the case and why it is targeting the bishops rather than individual hospitals:

Across the country, women face the risk of mistreatment as a result of the Directives. This happens often despite the fact that doctors want to give their patients the proper care and information, if only they were allowed to. Indeed, studies show that over half of OB/GYNs working in Catholic-sponsored hospitals have run into conflicts with the Directives. One doctor describes a miscarrying patient who was dying before his eyes, septic, with a 106 degree fever, her eyes filling with blood. But even though she was in danger, and the fetus had no chance of survival, because of the Directives, the hospital’s policy wouldn’t let the doctor treat her by terminating the pregnancy until the fetal heartbeat ceased of its own accord. Another doctor describes a situation where a woman in the first part of her second trimester arrived at the hospital with a hand sticking out of her cervix. But the fetus had a heartbeat, and so the Catholic-sponsored hospital forbids the doctor from ending the pregnancy. Instead, she was forced to send her patient to a facility 90 miles away. Doctors are also barred from giving their patients full information about their treatment options.

According to the ACLU, “The bishops aren’t doctors, and yet they issue rules that tie doctors’ hands, preventing them from giving their patients full information about their health care options and, in some cases, preventing them from providing medically appropriate care.” So when the bishops “remind” those at Catholic hospitals about Catholic teaching, what they are actually saying is that one must follow the teaching or risk being fired (and also being excommunicated if one is Catholic). That is not religious teaching. That is an ultimatum.

Women should not have to pay with their dignity, their autonomy, their health, and their lives to support someone’s religious philosophy. If Catholic hospitals cannot appropriately and responsibly treat women, then they cannot treat human beings.