Catholic healthcare institutions and the standard of care for treating women and girls
3 April 2023
Do Catholic healthcare facilities deviate from the standard of care for treating women and girls?
The standard of care is defined as the treatment for a disease or condition deemed proper by medical experts and that is widely used by healthcare professionals.
Catholic healthcare facilities are obligated to follow directives from the United States Conference of Catholic Bishops. These directives prohibit treatment deemed “immoral”:
Sterilization, including vasectomies and tubal ligations
Contraception, including birth control pills and reinsertion of IUDs removed during pregnancy
Abortion
Regarding miscarriages and ectopic pregnancies, Catholic healthcare institutions may force physicians to (a) delay an abortion until the pregnant woman or girl becomes “sick enough” or the fetus has died (i.e. there is no cardiac electrical activity) or (b) to transfer the woman or girl to a non-Catholic institution.
“The directives are not just a collection of dos and don’ts,” said John F. Brehany, executive vice president of the National Catholic Bioethics Center and a longtime consultant to the conference of bishops. “They are a distillation of the moral teachings of the Catholic Church as they apply to modern health care.” As such, he said, any facility that identifies as Catholic must abide by them.
These deviations from the standard of care are particularly important because:
Four of the ten largest healthcare systems in the country are Catholic (CommonSpirit Health, Ascension Health, Trinity Health, Providence St. Joseph Health) and they may dominate a geographic area. In 52 communities, a Catholic hospital is the only hospital within a 45 minute drive. When Catholic healthcare systems absorb other healthcare facilities, patients of the other facilities will face the limitations of Catholic healthcare facilities.
Overall in the US, one in seven patients is cared for in Catholic hospitals, but patients may not realize that their hospital or physician has Catholic ties or how that affects their care.
Catholic hospitals are often “not open and transparent” about these directives and how they limit care.
Patients often do not learn of the limitations until they are at a scheduled visit or in an emergency setting.
Physicians and other health care personnel in a Catholic healthcare system may not be comfortable talking about their limitations in this setting or about healthcare options available outside of the Catholic healthcare system.
Even in pro-choice states, the dominance of Catholic healthcare may limit reproductive healthcare. For example, in Colorado, a major hospital implemented a policy to deny women sterilization procedures as part of “conducting itself in a manner consistent with the ethical principles of the Catholic church ministry.”
In Southeast Michigan, the major Catholic healthcare systems are Trinity Health and Ascension Health. Other Catholic institutions are listed here.
Of note, even pre-Dobbs, similar practices were noted in Protestant and secular hospitals in the U.S. South.
Informed consent is the process in which a healthcare provider educates a patient about the risks, benefits and alternatives of a given procedure or intervention. But patients also need to be told if their healthcare facility is limiting care that would be offered to them at another facility.
Despite these significant restrictions on services, from a patient’s point of view, religious hospitals are often indistinguishable from secular hospitals. Religious hospitals may not have names that convey their affiliation; nor do they always disclose religiously motivated care limitations to patients. Therefore, patients may not be aware that they have entered a facility that does not provide all forms of care.
Thus, Catholic or other religious institutions should be required to tell patients ahead of time about limitations to their healthcare and offer to transfer them for the remainder of the pregnancy.
In addition, I suggest that individuals choose to get treatment at non-Catholic healthcare institutions, particularly if they support medical care for women and girls based on the best standards of the medical profession and not the directives of the US Conference of Catholic Bishops. This will benefit both the healthcare needs of women and girls in their families and may stem the rapid growth of Catholic healthcare systems that will limit the “best standards” for others.
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