A person seeking care in a Catholic hospital should be able to assume that advice given by a the hospital’s ethics committee would accurately reflect Catholic moral teachings. However, a recent event demonstrated that such an assumption is not always accurate.
In late 2009, the ethics committee of St. Joseph’s Hospital in Phoenix approved an abortion and claimed it was allowed under the Ethical and Religious Directives for Catholic Health Care Services (ERDs).
After much research and communications with St. Joseph’s and its owner, Catholic Healthcare West, Bishop Thomas Olmsted of Phoenix on Dec. 21 removed the “Catholic” designation from the hospital over its erroneous interpretation of and, in some cases, he said, failure to comply with the ERDs, a practice that had been going on for years.
Lowering of standards
The Phoenix incident dramatizes a lack of knowledge about, and compliance with, Church moral teachings by many of the people who sit on ethics committees and hand out life-and-death opinions.
Further investigation by Our Sunday Visitor also reveals that high standards for membership on ethics committees are absent in many Catholic hospitals.
Normally, hospital ethics committees are multidisciplinary, made up of social workers, chaplains, administrators, health care workers and perhaps members of the community. In addition to providing ethical consultations on specific patient cases, the ethics committees also usually review and write hospital policies on patient rights and organizational ethics and sometimes provide ethics education to staff.
However, a survey of chairpersons of Catholic hospital ethics committees that was published in the March/April 2006 issue of Health Progress, a journal of the Catholic Health Association of the United States, reveals a system in disarray. The survey found that it often is difficult to find people willing to serve on ethics committees, a commitment that is over and above their regular jobs. Sometimes, too, institutional support for an ethics committee is lacking.
Furthermore, most of the ethics committees surveyed had no criteria for membership: The survey found only 8 percent of the approximately 100 responding hospitals screened applicants for the ethics committee and for most, training for members was invitational only, with no requirements for participation.
Nor did most ethics committee heads think that certification or prerequisites for membership were a good idea: “Indeed, they said that requiring certification might cause problems, rather than solve them: It could undermine disciplinary diversity, increase the risk of displacing clinicians and patients as primary moral problem solvers, and add to the bureaucratization of health care.”
In its penultimate paragraph, the article stated: “In short, participation on HECs [hospital ethics committees] is generally perceived as a voluntary ‘add-on,’ rather than as ‘important enough’ to require serious training and resources.”
Capuchin Father Thomas Weinandy, executive director of the U.S. bishops’ Secretariat of Doctrine, told OSV that he was not aware of the 2006 survey, but was concerned over the apparent lack of standards.
“It hardly seems logical that people are making decisions regarding Catholic ethics and morals if they have no training in it,” he said.
However, even when people do have training, and even degrees, that is no guarantee of accurate knowledge of the Catholic moral tradition.
“Some of the ethicists that various Catholic health care institutions hire are really not fully in accord with Catholic moral theology,” Father Weinandy said. “The problem is that some have been trained in proportionalism, and that still can be part of their way in going about answering ethical dilemmas.”
David Belde, vice president for mission and ethics for Bon Secours Virginia HealthSource Inc., who has a doctorate in health care ethics from St. Louis University, told OSV that the field of ethics has expanded rapidly in the past 15 to 20 years. This dynamic, evolving field lacks standardization, he said, and there is ongoing debate over what kind of training a person should have who wants the title “ethicist.”
Many people do ethics as a second career, he told OSV, and even an advanced degree in ethics does not mean that person has any training in moral theory. Belde said it’s important for ethics committees to have members with clinical experience, like nurses and doctors, but ethics committees in Catholic hospitals at least should also have access to a consultant who has a strong background in Catholic moral theology.
John Haas, a moral theologian who is president of the National Catholic Bioethics Center, confirmed that people serving on Catholic hospital ethics committees generally don’t have much training in ethics. He told OSV that the center was approached several years ago by a cardinal and some bishops and asked to provide a means for a better and more uniform knowledge and application of the ERDs that would help people working in Catholic health care settings.
So, the NCBC created its National Catholic Certification Program in Health Care Ethics, and many of the people who have taken the Web-based distance course over the years are members of hospital ethics committees. (For details see www.ncbcenter.org.)
“The idea was to gain better knowledge of the Catholic moral tradition and greater uniformity in the application of the moral principles contained in the Ethical and Religious Directives,” said Haas, adding that the one-year, part-time course is achieving that goal, educating about 70 people a year.
Relationship with bishop
Joseph Piccione, a moral theologian who is senior vice president for mission and ethics at OSF Healthcare System based in Peoria, Ill., said it was very helpful for Catholic hospitals to have close communication with the diocesan bishop. In Peoria, a priest is the diocesan episcopal liaison for health care, and he works closely with the hospitals and the health system’s school of nursing, Piccione said.
This relationship with the diocese “builds collegiality and communion,” Piccione said. “You don’t get a sense the diocese is far away, but rather that we’re grappling with this together.”
He added that institutional support is essential for good ethics committees. The Franciscan Sisters of Peoria, who sponsor his system, have always made it a priority to provide ongoing ethics education at all levels in their hospitals, he said, with the sisters making clear the ERDs are hospital policy.
For sake of patients
It is unfortunate that ERDs are often portrayed as “a rule book,” Piccione said, when they are “a clear affirmation of human dignity” that state principles for application of that concept in clinical settings.
Nancy Valko, a registered nurse and president of Missouri Nurses for Life, and a spokeswoman for the National Association of Pro-Life Nurses, added that Catholic hospitals should seize the opportunity to “brand themselves” as being places where patients can feel comfortable knowing that all treatments are ethical.
Ann Carey writes from Indiana.
Committee Directives (sidebar)
Bishop Kevin Rhoades of Fort Wayne-South Bend, Ind., chairman of the U.S. bishops’ Task Force on Health Care, told Our Sunday Visitor that he was not aware of any past efforts by the bishops to create standards or criteria for membership on hospital ethics committees, and that issue had not been brought to the task force. He did note that ethics committees are covered in ERD 37:
“An ethics committee or some alternate form of ethical consultation should be available to assist by advising on particular ethical situations, by offering educational opportunities, and by reviewing and recommending policies. To these ends, there should be appropriate standards for medical ethical consultation within a particular diocese that will respect the diocesan bishop’s pastoral responsibility as well as assist members of ethics committees to be familiar with Catholic medical ethics and, in particular, these Directives.”