By Judy Stone | 7 May 2016
A disturbing report from the American Civil Liberties Union (ACLU) and MergerWatch, “Health Care Denied,” finds that one in six hospitals in the U.S. are operated in accordance with Catholic religious rules, known as the Ethical and Religious Directives (ERDs).
While perhaps best known for prohibiting abortion, the restrictions go far beyond that, and impact more than reproductive health.
For women, the impact can be deadly.
Abortions are prohibited even if the fetus has no chance of survival and the mother’s life is in danger. Savita Halappanavar died of sepsis in Ireland because her physicians would neither terminate her doomed pregnancy to save her life, nor transfer her to a facility that would care of her. Tamesha Means was luckier. She survived. Despite starting to miscarry at 18 weeks’ gestation, she says that Mercy Health in Muskegon, Michigan, sent her home, denying her appropriate care and putting her life at risk. There are similar, less well-known cases here, detailed in the ACLU report. Not providing emergency care is a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA) requirement for hospitals that receive Medicare funding—and Catholic health systems receive billions in taxpayer dollars.
In “Growth of Catholic Hospitals and Health Systems: 2016 update to ‘Miscarriage of Medicine’,” MergerWatch reports disturbing growth in Catholic-dictated health care. Between 2001 to 2016:
– The number of acute care hospitals that are Catholic owned or affiliated grew by 22 percent, while the overall number of acute care hospitals dropped by 6 percent
– There are now five states (Alaska, Iowa, Washington, Wisconsin and South Dakota), where more than 40 percent of acute care beds are in hospitals operating under Catholic health restrictions
– In another five states (Nebraska, Colorado, Missouri, Oregon and Kentucky), between 30 and 39 percent of the acute care beds are in facilities that are Catholic owned or affiliated
Physicians at Catholic hospitals have to agree to abide by the ERDs as a condition of obtaining privileges. Depending in part on the whim of the local bishop, this could include gag rules prohibiting counseling a patient or referring a patient to a place that would provide necessary services.
In Washington state, data shows that 40% of all hospital beds are in a Catholic hospital. There is no other option for care in entire regions. This is especially true in rural regions, and it is frightening when the only access to healthcare is dictated by someone else’s religious doctrine, rather than medical science.
For example, San Juan Island developed an affiliation with PeaceHealth, a Catholic health system. Now women on the island can’t get necessary reproductive care, a problem on other islands as well. There has been little detail available as to what compromises to patient care and autonomy the University of Washington made when it, too, affiliated with PeaceHealth. Washington’s Swedish Medical Center stopped doing abortions and closed its hospice after making a similar affiliation.
While these reports focused on restricted access to reproductive care, the Catholic directives also may interfere with end-of-life decision-making. Living wills may not be honored if they conflict with the ERDs—but you are likely not to know that before a crisis. Washington state, like Oregon, has a Death With Dignity law which allows “terminally ill adults to request and self-administer lethal medications prescribed by a physician.” But staff may be prohibited from speaking about Death With Dignity options, or from referring patients to organizations that can help provide that option.
I know about these restrictions intimately, in part because I opposed a merger here in Western Maryland between the secular Memorial Hospital and Sacred Heart Hospital, owned by Daughters of Charity. Part of the plan was to move women’s health to the Catholic facility—which would have meant that women who wanted to have a tubal ligation at the time of delivery would have had to travel a minimum of 1.5 hours over mountain roads to have their baby and surgery. For a safe abortion, I had to refer an indigent patient to Baltimore, three hours away, with no public transportation available. The end-of-life policy was changed to state, “Living wills will not be honored if in conflict with hospital policy”—but no one could tell me what that meant. As in Washington and elsewhere, affiliations or mergers are done behind closed doors and with little to no discussion with the affected community. Patients are often not aware of the restrictions on their care. In fact, despite looking carefully at one hospital’s website, I was unaware that my prospective employer was a Catholic-affiliated hospital until my privileges application asked me to agree to abide by the ERDs. Certainly there was no notice to patients, either, a far more critical issue.
The refusal to do tubal ligations during childbirth also means that a mother with a new baby has to have a second, unnecessary surgery and anesthetic risk, as well as the added recovery times, stresses and expense. Women often don’t have the option to go to another hospital. Sometimes they are limited by distance, or insurance restricts their choices. Leaving your home town to deliver your baby at an unfamiliar, distant secular hospital is prohibitively expensive, stressful and burdensome.
Women who have been raped and need emergency contraception will also not be able to receive appropriate medical care at a Catholic facility—which again increasingly is likely to be their only option. In fact, the ACLU, along with the California Medical Association (CMA), filed suit against Dignity Health in California, “alleging that the health systems violated a federal law requiring hospitals to provide emergency care and discriminated against women.” The CMA appropriately objected to the religious restrictions, noting that prohibiting tubal ligation forces “substandard care” on women and interferes with a doctor-patient relationship. They also assert that the restrictions violate a California legal doctrine that bars corporate interference with medical decisions.
As Lois Uttley, director of MergerWatch, observed, “As more and more acute care beds are in Catholic-owned or -operated hospitals, patients and even entire communities are losing access to health services that are not allowed by religious directives. The problem is particularly acute in the five states where 40% or more of the acute care beds are Catholic-operated, and in the 46 geographic regions where a Catholic facility is the sole community hospital.”
Healthcare decisions should be that—made between a patient and his or her physician, and not subject to anyone else’s religious beliefs. The rise in Catholic health systems hurts patients, particularly as patients are often unaware of the restrictions until they find themselves in urgent need of care. Hospitals must be required to clearly state what services they provide or deny. In my opinion, taxpayer monies should not be used to discriminate against patients nor given to facilities that deny appropriate and necessary medical care.
As the ACLU-MergerWatch report concludes, “Religious freedom in America means that we all have a right to our religious beliefs. But it does not give us the right to use our religion to discriminate against and impose those beliefs on others who do not share them—especially when doing so comes at the expense of women’s health and lives.”
Addendum 5/9/16: The Catholic Health Association statement on the ACLU-MergerWatch report can be found here. They summarize with, “These allegations, some of which have been the subject of since-dismissed lawsuits, are both unsubstantiated and irresponsible…”
The Catholic War on Women
Is Your Nearest Hospital a Catholic Institution?
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