Among the many, many consequences of the Supreme Court’s overturning of Roe v Wade is the spotlight it has placed on Catholic hospitals across the country with regards to reproductive health care. In states where abortion rights are severely restricted—especially in those states—it’s more important than ever that women have access to healthcare when their lives are in danger. That is not the priority in Catholic hospitals. And yet, as the Washington Post just explained yesterday, with Catholic hospitals rapidly swallowing up public facilities, the two sides are on a collision course.
It’s important to understand why Catholic hospitals are a problem. The main reason is that they’re essentially bound by the rules given to them by the United States Conference of Catholic Bishops—the USCCB. By and large, and with very few exceptions, they do not allow Catholic hospitals to perform any procedures that violate Catholic doctrine. If the hospitals violate the rules, they could lose their affiliation with the Church which could theoretically be the beginning of the end for many of those places. Even when they employ doctors and nurses who very much want to help patients, their hands are often tied.
Here’s just a glimpse of those rules:
Directive 45 says “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted.” What if a woman has an ectopic pregnancy, where the fertilized egg isn’t implanted in her uterus but gets stuck in the fallopian tube? That’s dangerous. Her life is at risk. A normal hospital could give that woman a drug to induce an abortion… or just remove that fertilized egg through surgery. Catholic hospitals won’t allow either one of those things because that would violate Directive 45.
Directive 48 says “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.” In other words, if the fertilized egg is in the fallopian tube, the USCCB still won’t allow doctors to fix the problem the easy way. In practice, that means doctors may have to remove a woman’s entire fallopian tube to prevent something fatal, reducing her ability to get pregnant in the future, even though it’s totally medically unnecessary, because that’s what the USCCB tells them to do.
Directive 52 targets contraception: “Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church’s teaching on responsible parenthood and in methods of natural family planning.”
Read anything about Mother Teresa and you will learn how her opposition to birth control put a lot of women from Calcutta in danger. But Catholic hospitals will not dispense it. If a woman who was sexually assaulted says she needs birth control immediately, and a Catholic hospital happens to be the one nearby, it may not help her. Some might, but it’s not guaranteed, and if there’s any chance the victim is already pregnant when the hospital sees her, that help is even less likely. The only form of contraception they will offer, even for married couples who don’t want kids, is Natural Family Planning (NFP), which is based around tracking a woman’s cycle so that she doesn’t have sex when she’s super-fertile. (Because as we all know, everyone only enjoys sex within a window of a few days per month and everyone’s really good at math and keeping track of things.) It’s hardly a reasonable alternative to contraception that is more effective, more often.
Directive 53 says “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.” Which means Catholic hospitals won’t perform vasectomies on men, or tubal ligations on women, because those would interfere with natural pregnancies in the future.
That one gets even more messed up. Let’s say you’re a woman who’s giving birth and you’re having a C-section because a vaginal delivery might be too dangerous. (That happens fairly regularly.) Let’s say that the woman decides, “You know what? I’m done having babies after this. No more kids for me. In fact, my health would be at risk if I had another baby, so tie those tubes.” (That also happens fairly regularly.) In fact, the best time to get your tubes tied so you physically cannot get pregnant is when you’re giving birth because the doctor has already made an incision in your abdomen, so tying your tubes is relatively easy. It’s far less risky than having two separate surgeries. Almost a third of women who have C-sections get their tubes tied in the process.
But doctors at a Catholic hospital won’t do that. They will perform the C-section, sure, but that’s it. They are forbidden from tying a woman’s tubes thanks to Directive 53.
Directive 40 goes after sperm donors: “Heterologous fertilization (that is, any technique used to achieve conception by the use of gametes coming from at least one donor other than the spouses) is prohibited because it is contrary to the covenant of marriage, the unity of the spouses, and the dignity proper to parents and the child.” That same religious logic forbids in vitro fertilization because that might involve the destruction of embryos. A couple can’t even use a surrogate mother to give birth to their biological child because that would also be seen as “gravely immoral.”
Basically unless your pregnancy is planned and there are no health issues, a Catholic Hospital may be your worst enemy.
You get the idea. And we haven’t even gotten into end-of-life care.
These Catholic hospitals have an obligation to the Catholic Church, not their patients. The Hippocratic Oath may say “Do no harm,” but the Catholic Church’s oath has a big asterisk next to that phrase that requires checking in with the pope first. And ultimately, the people they hurt the most tend to be low-income people, women, and LGBTQ individuals. People who may not have a choice in how or where they get health care, if they can get it at all. Even if they have insurance, it’s possible their policies require them to go to the Catholic hospital. Meanwhile, these hospitals get roughly $48 billion dollars a year in taxpayer money from the government—through Medicare and Medicaid reimbursements—to keep it all going.
If this were an isolated problem, that would be one thing. But it’s not. Catholic hospitals are taking over the country:
Four of the nation’s 10 largest health systems are now Catholic, according to a 2020 report by the liberal health advocacy organization Community Catalyst. The 10 largest Catholic health systems control 394 short-term, acute-care hospitals, a 50 percent increase over the past two decades. In Alaska, Iowa, South Dakota, Washington and Wisconsin, 40 percent or more of hospital beds are in Catholic facilities.
The same group notes that more than 30% of births in the U.S. now happen in a Catholic hospital.
In many states, you may have no choice but to go to a Catholic hospital depending on where you live. The Post reports that 1 in 7 hospital beds in the country are now run by a Catholic health care system and some states are worse than others. A 2016 report from MergerWatch found that 46 Catholic hospitals were the “sole community providers of short-term acute hospital care for people living in their geographic regions.” That means people in those areas have no choice but to receive non-comprehensive health care in certain circumstances. (I use the word “care” loosely.)
Making matters worse? Much like evangelical Christian bakers who don’t advertise their bigotry with a sign on the door saying who they will or won’t bake a cake for, Catholic hospitals don’t always advertise the services they won’t do—or even the fact that they are Catholic. Sometimes, these hospitals are named St. Something or Mercy Hospital and there’s a cross in the logo and it’s easy to figure out the connection, even if, like a lot of people, you don’t know what that means.
But sometimes their names are ambiguous on purpose. Like Dignity Health. You wouldn’t necessarily know that’s a religiously affiliated hospital.
In fact, in 2018, the New York Times looked at the websites of 652 Catholic hospitals and found that two-thirds of them didn’t even make it clear they were Catholic. It required at least three clicks from the home page to confirm that. And only 3% of those hospitals listed what procedures they do not perform.
What that means is that you may not know which hospitals are Catholic, and most people will have no idea what procedures are banned until it’s way too late.
With Catholic hospitals now taking over public facilities, the problems stemming from abortion restrictions are even more glaring, and it’s appalling how some hospital administrators don’t even seem to realize what’s happening, as the Post noted:
Kyle Kramer, chief executive of Day Kimball Healthcare, said the proposed affiliation with Covenant Health would rescue the financially challenged 104-bed hospital.
“Obviously it has connotations,” Kramer said of the proposed move to faith-based ownership. The Catholic directives would “provide guidance,” he said in an interview, while insisting that “the services that we have provided in the past are the same services that we will continue to provide in the future.”
Kramer did not answer questions in a follow-up email about how contraception and elective sterilizations could continue to be provided under Catholic doctrine if their primary purpose is for birth control. Nor did he specify how emergency obstetric care that could result in terminating a pregnancy might be affected.
I can answer that for him: Patients will be screwed. They won’t get the help they need because the Catholic Church doesn’t prioritize patient health.
There’s no simple solution here because, as Kramer alluded to, many public hospitals are severely underfunded. They’re looking for any lifeline, and the Catholic Church has money to toss around. But that partnership comes with the understanding that certain patients won’t get the care they need, even in emergency situations. It’s a Faustian bargain for those administrators.
(Portions of this article were published earlier)