Religious hospitals spark controversy with limits on care
Pressures put churches, health industry at odds
WASHINGTON — In Texas, a Catholic bishop made two hospitals cease doing tube-tying operations for women who are not going to have more babies. In Oregon, another bishop cast a medical center out of his diocese for refusing to discontinue the same procedure. In Arizona, a nun was excommunicated and the hospital where she works was expelled from the church after 116 years for allowing doctors to terminate a pregnancy to save a woman’s life.
Such disputes between hospitals and church authorities appear to be arising because of a confluence of factors.
Economic pressures are spurring greater consolidation in the hospital industry, prompting religiously affiliated institutions to take over or merge with secular ones, imposing church directives on them. At the same time, the drive to remain competitive has led some medical centers to evade the directives.
Alongside those economic forces, changes in the church hierarchy have led increasingly conservative bishops to exert more influence over Catholic hospitals.
The clashes have focused attention on the limitations on care available at Catholic hospitals.
Such conflicts are likely to intensify as new flash points arise, such as the spread of infertility treatments considered taboo by the church and the possible availability of therapies derived from human embryonic stem cells.
Although the issue has erupted at a variety of institutions, women’s health advocates are especially alarmed about Catholic hospitals, a leading source of health care in the United States.
“Physicians are being told they must refuse to provide certain services even when they believe their refusal would harm their patient and violate established medical standards of care,’’ said Lois Uttley, who heads MergerWatch, a New York-based group that fights the takeover of secular medical centers by religiously affiliated hospitals.
Last year, Caritas Christi Health Care, the hospital chain which had been owned by the Archdiocese of Boston, was purchased by a New York buyout firm and converted to a for-profit chain. Cardinal Sean O’Malley approved the sale to Cerberus Capital Management LP on the condition that the hospitals retain their Catholic identities, including ethical and religious directives, which will still be overseen by the archdiocese. Those directives prohibit practices the church deems morally wrong, such as abortion.
Church officials, bioethicists, and hospital officials argue that their facilities are guided by directives calibrated to deliver state-of-the-art medical care without violating religious and moral beliefs. Disagreements between dioceses and hospitals, as well as cases in which patients do not receive needed care, are exceedingly rare, they say.
“We have literally hundreds of institutions that care for men, women and children every day and provide excellent care, especially to the poor,’’ said Richard Doerflinger of the US Conference of Catholic Bishops Secretariat for Pro-Life Activities. “We always do so with respect for each and every life in our care.’’
Catholic hospitals are guided by the Ethical and Religious Directives, which detail moral justifications for care extending from conception to death. The interpretation of those directives is the responsibility of ethics committees at the hospitals, and the final arbiter is the local bishop.
The best-known prohibition is against abortion, which led to the recent confrontation between Bishop Thomas Olmsted and St. Joseph’s Hospital and Medical Center in Phoenix. In May, Olmsted declared Sister Margaret Mary McBride excommunicated after discovering that she had permitted a pregnancy to be terminated in 2009 for a mother of four who developed pulmonary hypertension in the 11th week of her pregnancy.
Doctors had concluded that the 27-year-old woman would almost certainly die without the procedure. But Olmsted demanded that the hospital take steps to comply with the directives. Hospital officials refused, leading Olmsted to announce that he was stripping St. Joseph’s of its Catholic affiliation.
Although some theologians question Olmsted’s ruling, a bishops’ committee chaired by Cardinal Donald Wuerl of the Archdiocese of Washington issued a statement that was widely seen as supportive.
Some observers, including some Catholic theologians, suspect Olmsted’s crackdown and the bishops’ statement could embolden other dioceses.
“I can see the chilling effect of this,’’ said the Rev. James Bretzke, a moral theologian at Boston College, who supports the directives but said he might now hesitate if a female relative sought some care at a Catholic hospital.
In addition to barring abortions, the directives prohibit tubal ligations, the surgical sterilization of women and the second leading form of contraception in the United States.
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