By Megan Cooley
Tuesday, February 4, 2003
A recent survey found that the majority of Catholic hospitals said they would not give women emergency contraception, even those who have been raped. In some states, such actions would mean those hospitals are breaking the law.
SPOKANE, Wash. (WOMENSENEWS)--After the assault of rape, a victim often encounters this advice: Contact a trustworthy person, don't shower and see a doctor immediately.
Another practice, however, might soon become more commonly prescribed--carefully consider the hospital in which to seek medical attention--after a survey released in December found that many Roman Catholic hospitals deny emergency contraception to rape victims.
The survey, commissioned by Catholics for a Free Choice, a Washington-based advocacy group that promotes issues of gender equality and reproductive health, found that only 28 percent of Catholic hospitals in 47 states and the District of Columbia would provide emergency contraception, also known as the "morning-after pill" or EC, to rape victims. Fifty-five percent of Catholic hospitals wouldn't dispense emergency contraception under any circumstances. The survey found that most of the hospitals that do provide emergency contraception set up barriers, such as pregnancy tests and police reports, before administering the drug.
Frances Kissling, president of the organization, asserts that when the law doesn't otherwise restrict it, the Catholic Church is using its hospitals to put its teachings into practice.
"What we are seeing is an increasing politicization of the Catholic hospitals by the Catholic bishops," Kissling says. "They are using Catholic hospitals as a way of enforcing Catholic beliefs that they have been unable to enforce through legislation."
In three states, however, some Catholic hospitals could be breaking the law, according to the survey's findings. Washington State, Illinois and California each has a law that requires emergency rooms to provide rape victims with information about emergency contraception. In Washington State, hospitals must provide the pills to rape victims if the women aren't already pregnant. But 6 out of 18 Catholic hospitals here told women inquiring about emergency contraception over the telephone that it wasn't available in their emergency rooms.
Spokespersons for the Catholic Church in Washington State say the official policies at their hospitals comply with state laws.
"What Catholic hospitals do is based on religious directives," says Sister Sharon Park, executive director of the Washington State Catholic Conference. "They follow the teachings of our religious beliefs, which are protected under the First Amendment." Those directives, called the Ethical and Religious Directives for Catholic Health Care Services, are sometimes vague and often have been interpreted differently, however. The directives were developed by U.S. bishops, with approval from the Vatican, and all health-care operations affiliated with the Catholic Church must abide by them.
In the case of emergency contraception, for example, the directives state: "A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction or interference with the implantation of a fertilized ovum." Because emergency contraception prevents pregnancy in one of several ways, including by preventing ovulation and interfering with implantation of the fertilized egg, some Catholic bishops have deemed it to never be permissible, while other clergy members, including Parks, say it's permissible in certain circumstances.
Ibis Reproductive Health, a Cambridge, Mass.-based research firm, conducted the survey for Catholics for a Free Choice last August. It sought to discover which hospitals administer emergency contraception and under what circumstances. Following a script, women trained by Ibis called 597 Catholic-hospital emergency rooms across the country. They attempted to make contact with each hospital three times over one weekend period. Callers asked questions of the triage nurse or whoever answered the telephone to simulate the expected experience of an actual rape victim. The callers never claimed to have been raped themselves, but they asked questions such as, "Do you give out emergency contraception?" and "So, even for women who have been raped, you don't give it out?" If the hospital employee asked the caller if she'd been raped, the caller replied, "I'd rather not talk about it."
The survey found that 23 percent of Catholic-hospital emergency rooms offered emergency contraception only to rape victims, and another 5 percent offered it without question. While more than 50 percent of hospitals denied emergency contraception under any circumstance, another 11 percent of respondents didn't know their hospitals' policies on the morning-after pill or were unable to answer the callers' questions. Catholics for a Free Choice purports that an obstacle such as this could deter an already-fragile rape victim from insisting on receiving contraception or accurate information about it.
At least 23 percent of the respondents either were unhelpful, suspicious or hostile toward the callers, the survey reports. The following comments were made when callers inquired about emergency contraception:
"No Catholic hospital will ever do that. They don't take rape cases."
"We're pro-life and all that."
"Go look in the Yellow Pages under abortion."
"Any hospital starting with "Saint" won't help you out."
Increasingly Catholic hospitals are merging with secular medical facilities and using names that are less telling of their religious affiliation, Kissling says, making it difficult to avoid medical centers with Catholic affiliations.
In Spokane, most of the medical facilities sit on the fringe of downtown, overlooking the city from their perch on Spokane's lower South Hill. The facilities here are the medical hub for the Inland Northwest, drawing patients from eastern Washington, Montana, Idaho, Utah and beyond. Among the South Hill's hospitals is the city's largest, Sacred Heart Medical Center, which twice told the Ibis callers that it never administers emergency contraception, the survey says.
Dr. Jim Shaw, chair of the 623-bed hospital's ethics committee, says if the hospital employees did refuse emergency contraception to potential rape victims, they were violating hospital policy. They might have misunderstood the callers' questions or weren't the appropriate people to be answering them, he says. If the callers used the term "morning-after pill," which he considers less "emergency" contraception and more like birth control, the respondent might have said that the hospital doesn't administer it since its policy only allows emergency contraception in cases of rape.
"I hope our hospital misunderstood the call and assigned it to a non-rape category," Shaw says. "We want to make sure we do what's right for" rape victims.
Holy Family Hospital, a 272-bed Catholic facility here, told callers that emergency contraception would be available to rape victims if they tested negative to a pregnancy test.
Rape victims don't always have a hill full of hospitals from which to choose, however. Health insurance policies often restrict patients' options and, in some areas, the only choice is a Catholic hospital, Kissling says.
Catholic hospitals receive often receive federal, state and even local government money if they are residents' only option in a particular area. In fact, religiously affiliated hospitals receive more than $40 billion in gross patient revenues from Medicare, Medicaid and other government programs, according to the MergerWatch Project, a division of Family Planning Advocates of New York State.
To Rev. Steve Dublinski, a spokesman for the Roman Catholic Diocese of Spokane, the emergency contraception issue isn't about hopping between hospitals or arguing the First Amendment. To Dublinski, the morning-after pill is "simply an abortive."
"The killing of a child is contrary to what we believe is correct," he says. If a woman becomes pregnant as the result of a rape, priests "try to move to her to a position where she's making a decision out of love for the child. Decisions made out of hatred are not good choices."
Dublinski claims Catholic women in this situation often have the baby and give it up for adoption.
"It takes great heroism and courage on the part of a woman to bear a child when she has been raped," he says. "We ask people to be followers of Christ. Sometimes that is a difficult thing."
Kissling argues that emergency contraception isn't abortion.
"People opposed to abortion should be the most active people supporting contraception," she says. "The Catholic hospital that's denying emergency contraception is actually contributing to" a higher abortion rate.
Kissling says she actually was pleasantly surprised by the survey's results and had expected fewer Catholic hospitals to offer emergency contraception to the callers. She says she expects more states to pass laws similar to Washington State's.
What continues to concern her, though, are the misconceptions some people have about emergency contraception and the possibility that medical centers who do not approve of emergency contraception might not be training their staffs to provide it.
Two of the comments from hospital employees called during the survey were: "Oh, is that what the morning-after pill is for?" and "Emergency what?"
Megan Cooley is a journalist in Spokane, Wash. Her work has appeared in publications including The Boston Globe and The Spokesman-Review.
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