By Ann Carey

'Shocking lack of understanding'

Bishops' consultant says many hospitals just don't know, or were led astray by confused bishops or ethicists

Dr. John Haas, a moral theologian and president of the National Catholic Bioethics Center, has long experience in working with bishops and Catholic health care institutions to correctly implement the "Ethical and Religious Directives for Catholic Health Care Services."

Three years ago, the NCBC initiated a National Catholic Certification Program in Health Care Ethics that was set up specifically at the request of a number of bishops who recognized the need for uniformity in the understanding and application of Catholic moral teaching in health care.

Our Sunday Visitor asked Dr. Haas to comment about the practice of Catholic hospitals doing sterilizations, which he said is indeed occurring in many parts of the country.

Our Sunday Visitor: Why are some Catholic hospitals providing direct sterilizations?

Dr. John Haas: There are several problems. First, you have a lot of non-Catholic physicians in Catholic hospitals. They are required to abide by the Ethical and Religious Directives, but they might not even know what they are or be familiar with them. Everybody knows the Catholic Church is opposed to abortion, but they are not as familiar with its position on sterilization.

Another difficulty is a lack of sound understanding of Catholic moral teaching, and I have found bishops making mistakes on this.

OSV: How could that have happened?

Dr. Haas: Ethicists are giving bishops bad advice, and some ethicists are unbelievably ill-formed themselves. The Catholic Church went through chaos in the late '60s, '70s and early '80s, and men going through seminary were being taught moral theology using a methodology that since has been formally repudiated by the Holy See --proportionalism. And proportionalism would have allowed these kinds of procedures. So you actually had priests with a master's degree in moral theology, for example, who were trained using a bad moral methodology.

I have read protocols in Catholic hospitals that have been formally drawn up and approved, sometimes even by bishops, that will say the only time a tubal ligation will be permitted is at the time of caesarean section when another pregnancy would pose a serious threat to the life of thewoman. That's a misinterpretation of Directive 53, which deals with the principle of double effect and says that sterilizations are permitted when their direct effect is the cure or alleviation of a present serious pathology and a simpler treatment is not available. The possibility of a future pregnancy is not a serious pathology.

People make mistakes, and that's a plain, flat-out simple mistake. What you actually have are two procedures, two moral actions: One is the delivery of the child and the other is a direct sterilization. So we've had to, on occasion, correct misunderstandings and re-write protocols.

OSV: So, such misunderstanding about the ERDs are widespread?

Dr. Haas: It's astonishing. Before I took this position -- and I've been president of Bioethics Center 12 years -- I taught moral theology, and I was incredulous to find what was actually going on in Catholic hospitals. But then as I pursued it, I found that to a large extent it was not ill will, but just a shocking lack of understanding of the ethical principles and their application.

OSV: Are the bishops aware of the problem and trying to address it?

Dr. Haas: Oh, yes. You now have bishops who are exercising far more ethical oversight of facilities than they have in the past. We work nationally, and we have seen a significant tightening up in this area across the country, and we're involved in it.

When one bishop found out sterilizations were occurring, he told the hospital to stop. The hospital thought the sterilizations were being done for good reasons, health reasons, and the hospital had on file a protocol approved by a previous bishop that was incorrect. So the bishop insisted they stop, and they did, and the hospital didn't go under.

Another bishop who has a health care system told the CEO of the system to bring in the Bioethics Center for a complete ethics audit of the entire system. Hospitals already have medical audits and financial audits, and they should have ethics audits, too. That sort of thing is happening, I'm very happy to say.