By Cynthia L. Cooper
Monday, October 23, 2000
Rapid expansion and mergers of Catholic hospitals with public and other non-profit institutions has resulted in a health care system in which religious dictates often overrule women's reproductive health care needs and choices.
In the rural coastal community of Newport, Ore., Rose Jade has been trying since last spring to get answers about whether the Ethical and Religious Directives for Catholic Health Care Services will apply to their municipal hospital, Pacific Community Hospital, which is proposing to enter into an operating agreement with the Catholic-run Providence Health System.
"The Catholic mission is perfect--unless you want an abortion," said Jade. She and three other citizens have challenged the pending contract in court, but she said Providence is the third largest employer in the state, and she and the other residents feel like ants facing an elephant. The city and Providence went to court asking the judge, as a kind of impartial mediator, to approve their contract in an action that would give the arrangement a stamp of judicial approval. "You don't have to put a spin on your religious practices to close a business deal," she said. "There's something wrong with that." Jade is still waiting for answers.
Across the country, women in need of reproductive medical care--birth control, abortion, tubal ligation, infertility treatments or emergency contraception--are increasingly being denied treatment and often experiencing grave consequences from the vast expansion of the Catholic healthcare network, in which religious dictates can take precedence over individual preference.
What makes this development even more alarming, hospitals affiliated with the Catholic Church have historically taken a leadership role to provide urgent medical care to those most in need, from lepers to impoverished immigrants, from pregnant women to newborns.
Catholic hospitals now constitute the nation's largest single group of non-profit hospitals, according to the Catholic Health Association of the United States, with 621 hospitals and 85 million patients in 1999. Of the 20 largest non-profit systems, 10 of them are Catholic. The mega-system, Catholic Healthcare West in California, added 12 hospitals in 1999 for a total of 48 hospitals, 8,172 beds and $5.9 billion in assets.
Catholics for a Free Choice, a pro-choice advocacy organization in Washington, D.C., reports that in the past 10 years, the number of Catholic medical care centers has grown rapidly through acquisitions, mergers, business arrangements and now consolidations. In 1998, the group says, Catholic hospitals were the sole providers of medical care in 91 communities--a 20 percent increase in a single year.
This is occurring at the same time that other hospitals, public and private, are shutting their doors or eliminating services.
Women in need of reproductive health care who find they must rely on a Catholic-run facility may suddenly encounter the strictures of the Ethical and Religious Directives, adopted by the church's National Council of Bishops in 1994, which applies to all U.S. Catholic institutions. It explicitly states that abortion "is never permitted." It also prohibits sterilization, including tubal ligation, the most commonly used method of birth control in the nation, as well as other legal reproductive health services. The religious proscriptions apply to all patients, regardless of their individual religious beliefs.
"People often don't understand (Catholic prohibitions) until they are in a situation where they need a particular service," says Elena Cohen, director of the Health Care Provider Merger Project of the National Women's Law Center in Washington, D.C.
In St. Petersburg, Fla., city officials claim they were unaware that the Ethical and Religious Directives would apply to a city hospital, Bayfront Medical Center, when they entered into a business arrangement in 1997, along with three secular hospitals and two Catholic institutions, according to attorney Marcia S. Cohen. She was lead counsel in a lawsuit filed last August challenging the application of religious directives in a government-owned hospital as a violation of the separation between church and state.
The hospital also was sued by women's groups and the American Civil Liberties Union, alleging violation of the separation of church and state. Joining as plaintiffs are the American Civil Liberties Union, Americans United for Separation of Church and State, National Organization for Women foundation and Planned Parenthood of Southwest and Central Florida.
On Monday, Bayfront announced that it would leave the business arrangement by the end of the year.
At Bayfront, the only public facility in one Florida county, a nun reviewed all medical decisions to ensure that they conformed to the Ethical and Religious Directives. The lead counsel in the women's and civil liberties lawsuit, Marcia S. Cohen, said in the lawsuit that, as a result of religious directives, one patient was forced to carry a severely deformed fetus to term. "She was depressed for years," Cohen said. "Tremendous havoc has been wreaked on this family."
Plaintiffs also criticized the hush-hush manner in which reproductive health care services were eliminated, an alleged violation of "sunshine" laws requiring the government to operate in a manner open to public scrutiny and debate in Florida.
Other indices also document the loss of important services to women. A small pilot study of emergency rooms in 58 large urban hospitals in Washington, D.C., and 10 Eastern states found that 12 of 27 Catholic hospitals prohibited discussing emergency contraception with rape victims. None of the 30 non-Catholic hospitals had such restrictions. In emergency contraception, time is of the essence because medication is only effective within 72 hours after coitus.
"You could make a case that (banning emergency contraception) is abandonment of the patient," said a critic of the policy, bioethics Prof. Jon Merz of the University of Pennsylvania, an author of the study, which was peer-reviewed.
Communities also must sort out the varying policies among Catholic hospitals. Each of the 146 dioceses in the nation has some authority to interpret the Ethical and Religious Directives, according to Rick Hinshaw, associate director of communications for the New York State Catholic Conference. "They all flow from the Church's teachings," said Hinshaw, "but they are not exactly implemented in the same way."
But Sister Sharon Euart, associate general secretary of the National Council of Bishops and a lawyer, said that the directives are "binding and apply to any health care service under the aegis of the Church."
Hinshaw explained that Catholic hospitals do tell people whether certain procedures are prohibited--if they ask. Hospitals do not proactively announce banned procedures, any more than secular hospitals post lists of services that are not available, Hinshaw said.
"Communities are starting to wake up to this threat to reproductive health," said Lois Uttley, director of the MergerWatch Project of the Family Planning Advocates of New York State, which has become a key national resource on the subject.
Eight communities defeated proposed mergers, through organizing politically, demanding services and maintaining vigilance.
In one of them, a joint Catholic and non-Catholic health care center in Enid, Okla., was rejected because 200 people objected when they learned that tubal ligations would be prohibited.
But, in other places, "creative solutions" to save reproductive health services have been overruled or broken. In Palm Beach, Fla., for example, reproductive health services were to be maintained at a non-Catholic hospital when it merged with a Catholic system. Four years later, the non-Catholic ward was closed, leaving only the Catholic facility.
"You run into a very serious clash of religious and individual patient rights," says Uttley. "This is something women need to become educated about and sophisticated about. We need to insure that choice is preserved."
Cynthia L. Cooper is a New York-based free-lance writer specializing in reproductive health care issues.
See also Part 2 of this series: