By Ann Carey

Threats to Catholic health care

Hospitals, providers faithful to Church teaching are under threat from groups hoping to erode conscience rights

The topic of health care reform is in the news today as President Barack Obama's administration and Congress struggle with writing a plan to increase medical coverage in a financially responsible way.

In the process of this debate, we hear a great deal about problems facing health care today, but not much attention is given to the additional problems facing Catholic health care in a culture that does not share Catholic values regarding the dignity of human life.

"Catholic health care is in the middle of some of the toughest debates in American life --abortion, euthanasia and health care itself," said John Carr, executive director of the Department of Justice, Peace and Human Development for the U.S. Conference of Catholic Bishops. "The biggest challenge is keeping faith with the mission in challenging times."

Carr said he is impressed with the efforts Catholic hospitals make to integrate Catholic teaching into their identity and into the way they carry out their ministry, but "it's a really tough time with dramatic change in health care financing, very significant ethical challenges, 40-some million people without coverage and immigrants who have no status," Carr said. "And yet, Catholic hospitals carry out the healing ministry of Jesus in our own time in lots of places."

Multiple threats

However, this mission is getting more and more difficult to accomplish, for ethical challenges are being thrown at Catholic health care from many directions: abortion-rights advocates, groups such as Planned Parenthood, secularists, professional organizations and government entities at local, state and federal levels.

Americans United for Life (AUL), a public interest law and policy organization that tracks such challenges, has concluded that there is an "increasing threat to health care rights of conscience by groups and individuals who believe that health care providers who oppose abortion, contraception, and immoral uses of biotechnology should 'get out of the profession.'"

Their strategy is "clever and chilling," according to an AUL brief on the topic:

"If they can create legal precedent to compel violation of conscience for one procedure (e.g., dispensing contraceptives) or group of health care providers (e.g., pharmacists), they will have established the legal precedent necessary to compel doctors to participate in surgical abortion and to compel all health care providers to participate in other objectionable procedures and services."

It's important to note, the AUL points out, that conscientious objections are most often raised concerning elective services, such as abortion, contraception, sterilization, physician-assisted suicide and withdrawal of nutrition and hydration, rather than necessary or lifesaving services. "Therefore, the lack of participation in these practices by a health care provider or institution will not endanger the lives or health of patients."

Carr agreed: "There is a deliberate effort to push the Church out of health care. They don't like who we are and what we stand for; it's real. I always find it ironic that politicians say we do wonderful work, and they don't understand that the reason we do wonderful work is because of what we believe. And we have a right to believe what we believe.

"If they're going to celebrate our contributions to the common good, then they have to protect our participation consistent with our values in advancing the common good."

Loss of identity

Leonard J. Nelson III, author of "Diagnosis Critical: The Urgent Threats Confronting Catholic Health Care" (Our Sunday Visitor, $29.95), expects Catholic hospitals to come under increasing government pressure to facilitate access to a full range of so-called reproductive services, which will include sterilization and abortion or abortion referral. Nelson believes such pressure will come from new conditions being placed on access to government funding, limitations placed on participation in government programs or mandates to provide all reproductive services.

"The difficulty that both institutional and individual health care providers face in successfully seeking exemption from laws mandating the provision of reproductive services is exacerbated by the contemporary view of conscience as a judgment that is based on one's own life experiences, rather than on objective truth," said Nelson, who is a law professor at Cumberland School of Law of Samford University in Birmingham, Ala.

"In a secular, liberal democracy like the United States, where ethical relativism has become the prevailing public philosophy, an appeal to conscience, based on objective moral truth, is likely to be met with skepticism and even hostility," he told OSV.

Nelson also worries that promised conscience protections will be interpreted to mean that a Catholic provider may refuse to provide morally objectionable services only if the service is readily available from another person or entity in that particular geographic area. He also believes that any public health plan will cover abortions and sterilizations, and Catholic hospitals could be required to provide those services in order to participate. And, of course, not participating in a public plan could mean financial disaster for a hospital.

"It's possible that the greatest threat to the continuation of distinctively Catholic health care will result not from a frontal assault on conscience protection, but from a process of incremental erosion of Catholic hospitals' commitment to the 'Ethical and Religious Directives for Catholic Health Care Services' (ERD)," Nelson said. "And if the bishops refuse to permit Catholic hospitals to provide these procedures, some will continue operations as secular, nonprofit organizations unaffiliated with the Catholic Church."

Nelson cited the recent announcement that the board of Trinity Medical Center in Brenham, Texas, has decided to separate from its parent company, Franciscan Services Corp. of Sylvania, Ohio, and relinquish its Catholic identity. After a July 2008 Our Sunday Visitor article reported that many Catholic hospitals in Texas were providing direct sterilizations because of a flawed interpretation of the ERD, some Texas bishops insisted that hospitals honor the proper interpretation of the ERD. Consequently, Trinity's board decided to continue providing sterilizations that are not permitted under the ERD and made the decision to drop the Catholic identity.

The May issue of Catholic Health World reported that the Trinity chief executive explained the decision was made because Trinity was the only facility in town for obtaining a sterilization, and the board felt patients should not be transferred out of town.

Pressuring providers

Catholic health care institutions are not the only Catholic entity encountering challenges, for Catholic doctors, nurses and pharmacists also are experiencing pressures to provide immoral services. John Brehany, a theologian and ethicist who is executive director of the Catholic Medical Association (CMA), told OSV that Catholic health care workers also struggle with conscience and financial issues in the current U.S. health care delivery system. The CMA is the largest professional association of Catholic physicians and health care providers in the United States.

"Faithful physicians and health care providers -- from medical students to hospitals -- face significant challenges to conscientious belief and practice, as practically all Catholic teachings on respect for life are under attack," he said. "These attacks come subtly in applications for medical school and residency, in practice as some patients or partners object to refusals to perform sterilizations, etc., and, of course, from advocacy groups that actively seek to remove legal protections for conscience rights."

On the financial front, Brehany said that Catholic physicians also suffer from the well-known failings of the health care delivery system in the United States. Government programs routinely underpay physicians for their services, and insurance companies also demand discounts and force physicians to deal with onerous reimbursement procedures. Additionally, refusing to participate in procedures such as sterilization or writing prescriptions for contraception further reduces earning potential, he said.

There is no simple solution to the health care dilemma such as government-controlled, universal health care, Brehany said. Rather, "authentic health care reform, consistent with authentic Catholic moral and social teaching, is urgently needed."

A historical perspective

For more than 275 years, the Catholic Church in America has cared for the health needs of citizens, often those most vulnerable in society. Here is a look at some key dates of Catholic influence in caring for the sick, poor and most vulnerable in the United States:

1728 - A year after arriving in New Orleans, Ursuline Sisters open Charity Hospital, the first privately owned Catholic hospital in what would become the United States.

1860s - During the Civil War, Sisters of the Holy Cross become first women to serve as Naval nurses. They are stationed in Navy facilities and aboard the USS Red Rover, a hospital ship for the Mississippi squadron.

1861 - The Daughters of Charity of Emmitsburg, Md., open Providence Hospital in Washington, D.C. Later, it is chartered by President Abraham Lincoln.

1886 - Hospital Sisters of St. Francis open country's first Catholic nursing school at St. John's Hospital in Springfield, Ill.

1900 - Dominican Sisters of Hawthorne, founded by Rose Hawthorne, establish St. Rose's Free Home For Incurable Cancer in Lower Manhattan to provide hospice care for indigent patients.

1915 -Catholic Hospital Association is founded in Milwaukee, Wis. It is later renamed Catholic Health Association of the United States.

1932 - National Federation of Catholic Physicians Guilds is established under the leadership of Dr. R.A. Rendrick, M.D. In 1997, it's name is changed to the Catholic Medical Association.

1939 -Sister of Charity of St. Augustine Ignatia Gavin is among founders of Alcoholics Anonymous at St. Thomas Hospital in Akron, Ohio.

1981 - U.S. Conference of Catholic Bishops releases its "Ethical and Religious Directives for Catholic Health Care Services." It is updated three times, most recently in 2001, when the fourth edition is approved at the U.S. bishops' June 2001 meeting, superceding the previous editions.

Sources: Catholic Health Association, Catholic Medical Association, U.S. Navy, U.S. Conference of Catholic Bishops

Ann Carey writes from Indiana.