When religious doctrine attempts to undermine medical ethics, patients suffer
Picture this: Pregnant and in pain, a woman arrives at her local hospital. She is told her fetus will not survive, but without medical intervention, neither will she. As her condition worsens, her doctor refuses to provide her care until the fetal heartbeat stops—endangering the woman’s life in the process. A man is admitted to a hospital following a serious motor vehicle crash. Brain damage causes him to lapse into a coma. Doctors check his advanced medical directives, noting he has requested no artificial nutrition or hydration. Denying his explicit wishes, they administer the treatment anyway.
A doctor cares for a pregnant patient wishing to be sterilized immediately after the delivery of her child—a common and safe practice that avoids unnecessary additional hospitalization or procedures. The patient has a brain tumor, and a future pregnancy would put a severe strain on her health. Despite this serious condition and the doctor’s recommendation to provide this care, the hospital prohibits him from performing the procedure.
These circumstances are not select horror stories from nonaccredited hospitals or unqualified providers. They are the story of Catholic healthcare across the United States acting against the best interest of its patients. Catholics for Choice’s latest report on Catholic healthcare, Is Your Health Care Compromised?, illustrates this threat to quality healthcare in the United States.
Catholic hospitals make up one in six hospital beds in the United States and serve more than 5 million patients per year. These patients arrive at the hospital doors unaware of any Catholic affiliation and expecting to receive quality, comprehensive care. But what they have found instead is that miscarriages in progress are dismissed with a dose or two of Tylenol, emergency contraception is provided only after a sexual assault and only if there is proof the woman isn’t pregnant and in vitro fertilization is not an option, even for married couples who cannot conceive naturally. This divergence from standard medical practice at Catholic hospitals rests on one sole doctrine—the Ethical and Religious Directives for Catholic Healthcare Services.
These directives were originally drafted by the United States Catholic Conference of Bishops (USCCB) in the 1940s. Throughout the years, they have been updated and expanded with an increasing number of restrictions on reproductive health services, now applying to all Catholic hospitals with the force of canon law. Bishops without medical education or training interpret the 72 directives, and have decreed that even hospitals and healthcare centers that merge, partner or merely affiliate with Catholic institutions must strictly adhere to the restrictions.
Doctors are required to take the Hippocratic Oath, committing themselves to uphold ethical standards of medicine and affirming that “Above all, [they] must not play at God.” But bishops need not adhere to any such promise, and as a result, religious doctrine has crippled the standard of care in Catholic healthcare facilities for decades. Acting as both authors and interpreters of the Directives, bishops are given the final say in patient care within these institutions—giving them veto power over the medical expertise of healthcare providers. In these facilities, women have no access to abortion, modern contraception (including sterilization) or in vitro fertilization, and providers may not defer to their patients’ advanced medical directives.
Many people arrive at hospitals and healthcare centers by no choice of their own. In emergency circumstances, patients are brought to the closest hospital. The problem arises in areas where 20 percent of sole community hospitals—hospitals located at least 35 miles away from other hospitals or located in a rural area—are Catholic affiliated. People in need of immediate care often learn of the restrictions in Catholic facilities too late, and are geographically left without other options. For example, one woman in California requested a tubal ligation at the same time as her scheduled C-section. The Catholic hospital where her procedure was set to take place denied this request, relying on the restrictions in the Directives. In search for other options, she found that the other hospitals in the area were also Catholic and held to the Directives. To have the tubal ligation covered by insurance, her only real option was to travel more than 160 miles to get the procedure.1
Even seemingly secular hospitals can be dangerous places for patients. A woman in Washington State arrived at Swedish Hospital, 24 weeks pregnant and miscarrying. Her doctors told her that they could not save the fetus, but since it still had a heartbeat there was nothing they could do. What the woman did not know was that a year earlier Swedish Hospital had formed an alliance with Providence, a Catholic healthcare institution. Per the terms of the alliance, Swedish agreed to stop performing abortions unless it was an emergency circumstance. Aside from the obvious fact that this pregnant woman was indeed in crisis, she had no way of knowing that the religious restrictions from the Directives would be imposed on the seemingly secular hospital at which she had arrived.
These limitations place too many patients, who entrust healthcare providers with their care and their lives, in extraordinarily vulnerable circumstances. Some patients are never told about their treatment options, let alone about the restrictions on care the facility forces on them. Others are told they may travel to the nearest secular hospital, which is often a great distance away—all while their bodies are in distress. Many patients cannot afford the cab fare to ride dozens of miles to the next hospital, or their condition does not allow for it, and they are stuck with insufficient care.2
Catholic healthcare affects not only the Catholic faithful who believe in these practices. It imposes religiously motivated restrictions on patients of all faiths and no faith who seek care at Catholic institutions. Regardless of what their own beliefs may be, patients are denied healthcare options that don’t align with the Catholic hierarchy’s Directives. Yet Catholic hospitals are not actually in the business of providing spiritual guidance or religious consultations. They were founded with the intent of providing medical services to the poorest and most marginalized individuals in communities, regardless of their faith.
Bishops without medical education or training interpret the 72 directives, and have decreed that even hospitals and healthcare centers that merge, partner or merely affiliate with Catholic institutions must strictly adhere to the restrictions.
What is more, Catholic health systems run on billions of dollars from taxpayer dollars—yet are exempt from providing the full range of healthcare services or complying with current medical standards. In the United States, eight of the top health systems are Catholic-owned or affiliated. These eight systems are also among 25 of the largest hospital systems in the country. In 2015, these systems billed roughly $120 billion in gross revenues to Medicare and Medicaid. The third largest health system in the country alone increased its Medicare revenue from $2.8 billion in 2001 to $17 billion in 2015. Despite the fact that this funding stream is likely to increase, patients obtaining healthcare at these hospitals are not receiving the same quality of treatment offered at other facilities, even though Medicare and Medicaid require it.
So, what has made this 21st-century version of Catholic healthcare possible? Why are Catholic hospitals permitted to provide medical services so far below the accepted standard of care, and allowed to disrespect patients’ own beliefs and consciences? The answer is simple: The political power of Catholic advocacy organizations and their influential lobbying machines have made it possible. The USCCB and the Catholic Healthcare Association of the United States (CHA) frequently align on the same policy positions, vowing to “promote and carry on Catholic activities” and “strengthen the viability of the Catholic health ministry,” respectively. In particular, both maintain that the Directives are drawn from Catholic theology and moral teachings, when in actuality they misrepresent the core Catholic tenants of conscience and social justice. Despite this delusion, their proud ownership of the Directives as a reflection of Catholicism immediately raises religious liberty flags on which our nation was founded. When an institution is allowed to substitute religious doctrine for medical science, there is no denying that religious liberty is under attack. The USCCB, CHA and their conservative allies manipulate ideas of religious liberty to allow discrimination against anyone who attempts to make a decision contrary to their version of Catholicism. In Catholic healthcare facilities, Catholics and non-Catholics alike are denied their rights to make conscience-based decisions about their healthcare. Instead, their First Amendment freedom of and freedom from religion is cast aside to accommodate the beliefs of the few powerful voices in these Catholic advocacy organizations.
Catholic healthcare may be expanding its reach, but advocates for religious liberty and reproductive health are fighting back against religiously motivated healthcare discrimination. National organizations like Catholics for Choice, MergerWatch and the American Civil Liberties Union (ACLU) have reported on the magnitude and very real consequences of restrictions in Catholic healthcare for years, and state advocates have begun fighting in their legislatures. For example, we have successfully rallied alongside the ACLU of Illinois and other state advocates for passage of an amendment to the Illinois Health Care Right of Conscience Act. This amendment ensures that a patient will receive accurate medical information and treatment options consistent with current standards of medical practice even if a provider or institution objects to giving that care. This includes a referral, transfer or information on where to seek the services and transfer of the patient’s medical records in a timely manner. While the law does not require Catholic healthcare institutions to provide treatment, it takes steps to provide patients who were denied healthcare services the information they need to access those services elsewhere.
The law appeared to be a decent compromise between protecting conscience objections and patients seeking care, yet it still faced fierce opposition from prolife organizations. Illinois Right to Life and the Alliance Defending Freedom, two organizations that seek to eradicate reproductive health options or religious exercise that doesn’t align with their own beliefs, made the absurd statement that the law “attempt[s] to rob women of the freedom to choose a pro-life doctor.”3 The law now faces a challenge in Illinois state court, creating a “quicksand” scenario in which a judge must now decide whether the requirement to provide information on services objected to places a burden on the “liberty of conscience.”4 Yet we know from the stories above that the true threat to conscience results when women are robbed of information and access to their healthcare options.
The illusion that delivery of healthcare services is uniform across the country disintegrates when the realities of Catholic healthcare are exposed. The one-in-six chance of ending up at a Catholic-owned or affiliated hospital or healthcare center is no longer a difference of seeing a cross adorn a building, but instead a matter of your health and life. The latest report by Catholics for Choice, Is Your Health Care Compromised?, digs deep into the history and impact of Catholic healthcare, showing how religiously motivated healthcare discrimination threatens lives and undermines the trust between healthcare providers and patients. It provides in-depth guidance on what you, as a patient, provider, elected official or journalist can do to protect access to reproductive healthcare at Catholic hospitals. We know that Catholic healthcare can and should do better—and now it is time to demand it.