At the intersection of Catholic politics and American healthcare

Writing in the Guardian, Becky Garrison says:

[C]urrently there are 600 Catholic hospitals in the United States, comprising about one-fifth of all hospital beds. Also, about 45 Catholic hospitals in the US are sole providers, meaning they’re the only hospital serving a community. As reported by The Revealer, a daily review of religion in the news and the news about religion, “these hospitals are governed by 72 ethical and religious directives that are written by the USCCB and enforced by the local bishop”.

While Catholic hospitals receive about half of their funding from the Federal government via Medicare and Medicaid reimbursements, Catholic hospitals can claim exemption from federal laws through a web of “conscience” clauses. Ann Neumann, editor of the Revealer, observes: “In most Catholic health care facilities, the conscience of the church supersedes the rights of patients and individual doctors by limiting care services according to Catholic doctrine. Men, women, the elderly, the poor and the victimised – effectively, entire communities served by Catholic hospitals – suffer a drastic and often traumatic loss of patients’ rights when information or services are denied, particularly when a Catholic hospital is the only game in town.”

Bryan Cones, managing editor of US Catholic, a lay-edited national Catholic monthly magazine, places this debate within the larger framework of the ongoing discussion surrounding the intersection of Catholic faith and public healthcare in the United States. “The bishops in general and Olmsted in particular are insisting that their prudential judgment must be followed; that was the US bishops’ position on the healthcare reform bill. I think it is unprecedented in the US Catholic church that the personal judgment of a bishop on a particular ethical situation has to be affirmed by a Catholic organisation or individual.”

Is the “web” of conscience clauses too loose? Are Catholic bishops making decisions best made by patients and physicians? And if so, should the government be supporting hospitals in which this occurs with your tax dollars?

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  1. Michael Lockaby

    It’s not news that the Roman Catholic Church is moving to make itself more pure (the Vatican Bank excluded) and less relevant. I also have no problem with them taking federal money—for what it’s worth, it’s perfectly constitutional and has been established as such since 1899, assuming the corporate formalities are set up right, which any competent lawyer could do—especially if it’s filtered through choices made by patients, rather than a direct subsidy. Regardless, though, it’s rather premature to be debating this when we’re still fighting to make sure all Americans can get health care of any type at all, no?

    Mike Lockaby

  2. Paige Baker

    Is the “web” of conscience clauses too loose? Are Catholic bishops making decisions best made by patients and physicians? And if so, should the government be supporting hospitals in which this occurs with your tax dollars?

    Yes. Yes. No.

    Next question: Is there anything we can do about it? And the answer is: “Probably not.”

    That the USCCB was able to convince members of Congress to vote against the Affordable Care Act by making totally false claims that it would allow Federal funding for abortion tells me that we don’t have a prayer (pun intended) of ensuring patients’ rights for those in Catholic hospitals.

    It also tells me that the American public–and especially our elected officials–have the attention span of gnats and ought not to be allowed out in public alone….

  3. Don’t get me started!

    In short, the RC hospitals which are governed by the USCCB directives should not receive public money. I don’t know what solution to suggest for the communities with only a RC hospital to serve them.

    June Butler

  4. The Rev. Richard E. Helmer

    I remain fascinated and appalled by how easily the line between “conscience” and control gets blurred.

  5. tgflux

    Exactly, RichardH.

    For the USCCB, it’s “Your rights stop at the tip of my nose, my rights extend to cutting off your oxygen [if you would be using the oxygen to have an abortion that, while it saves you, terminates the Uber-Precious ‘Unborn’].”

    Why don’t the Popoid bishops issue an edict that, henceforth, faithful Catholics must celebrate their Conception Days, not that “Culture-of-Death” invention, the “birthday”? [And then ban EVERYBODY (RC or not) celebrating their birthdays in Catholic hospitals?!]

    JC Fisher

  6. LA Episcopal priest

    How about liberal Protestants opening their own hospitals and running them according to their own ethics and leave the Catholics to run their own hospitals?

    JC Fisher,

    Lose the juvenile “popoid” and just say “Papist” like the Know Nothings of old. And to think that the history books tell kids that the Know Nothings disappeared in the 1800’s. I think they have been reincarnated in the Episcopal Church– at least one gets that idea from reading this TEC blog.

    Fr. William Ledbetter

    PS, I hope you keep your politics off my local Catholic hospital and all the rest of them, too.

  7. Care, siblings. Providers have rights, too, to control their practice and not to violate conscience. The same right to practice allows a physician to refuse to perform an abortion or to refuse to provide care that delays death without benefiting the patient. This applies whether the provider is an individual or an institution.

    It is distinctly difficult when there is only one provider, whether it’s a physician, a pharmacist, or a hospital. Since licensure for all three is a function of states, there have been some efforts to address it. For example, Illinois has set some limits on provider rights in such situations. At the same time, the Bush administration issued an executive order expanding provider protection well beyond licensed professionals, an order that was rescinded in one of the first actions of President Obama. This didn’t remove provider rights, but returned to the status quo ante.

    Marshall Scott

  8. Paige Baker

    How about liberal Protestants opening their own hospitals and running them according to their own ethics and leave the Catholics to run their own hospitals?

    Not very practical in those locales that can only support one hospital, is it?

    Non-Catholics in those situations should not be held hostage to Catholic doctrine–whether or not the funding is public.

    Marshall–conscience clauses typically require providers to refer patients to another healthcare professional who will perform the procedures/services the patient needs or desires. How does that work in a Catholic hospital that is the only game in town?

  9. Jeffrey L. Shy, M.D.

    @Fr. Ledbetter,

    I think those of us of more liberal bent here (and there is no doubt that this blog is center-left, if you want a conservative one, you have lots of other choices), would value a contribution from a thoughtful Anglo-Catholic person that was part of the discussion, not just an attack on someone else’s admittedly forcefully expressed opinions. I for one, would value your thoughts from a “Catholic” perspective on these difficult issues. Just insulting the rest of us “en masse” promotes division and anger, and does nothing to forward any alternative views. I would agree, however, that we should be careful to address those with whom we disagree in reasonably respectful terms, so I would not be happy with just blank “anti-Catholic” statements either.

    I, for one, feel that there is a reasonable principle that Catholic hospitals should run their institutions on whatever ethical principles that they feel most comfortable with. Ditto for Jehovah’s Witnesses, Jains, Christian Scientists, etc.

    The more sticky issue is when one is in a region (not LA, where there are lots of “choices”) or area where there is no “choice” for an ill person to go to a hospital that might be more compatible with their own religious beliefs. For many persons, the only option for hospital care is a Catholic institution, and they obviously do receive public funds. The mere fact of their existence might preclude the possibility of having a “competitor” as there are simply not enough resources (nurses, staff, physicians, etc) to support a second “secular” option. What should the responsibility be of the hospital to respect the consciences of the clients that come as they have no other choice to their doors? In the Phoenix case, had the hospital adhered to the most narrow/literal interpretation of the “rules,” the mother would be dead, the fetus dead and four children without a maternal parent. This would be an enforced imposition on a person against their own religious scruples and one with lethal, not just matter of convenience, consciences. The “conscience” of the hospital would be preserved, but the mother would be dead as a result of that decision of “conscience.”

    As a physician, I do believe that the “rights” of providers has a reasonable place in medicine, but would always place the “rights” of the patients whom we serve in first place. As a neurologist, I run into issues like this when there are concerns of brain death or persistent vegetative state. In those cases, I believe that my role is that of providing an accurate diagnosis as well as the likely outcomes based on the best scientific data to which we have access. It is also my role to ensure that the persons making decisions based on that diagnosis/prognosis understand what the scientific perspective is. Beyond that, I do not try to dictate what their decision might be. I try to tell them what things “might be like” in each of the alternative choices they might make. For example for continuing the physical life of a brain dead individual, what that will be like for the short and long term. I also make it clear that many decisions are not irrevocable, and when one decides against life-continuing treatments, for example, the decision can be reasonably reversed as long as that is physically possible.

    Through all of this, however, I try to remain as neutral as possibility regarding my own moral/ethical beliefs. This has served me well over time.

    I wonder, would we consider it ethical to enforce “Catholic” or “Protestant” or “Liberal” behaviors on individuals involuntarily in other circumstances? What if I make it a law (as has been the case in places in the past) that one must attend Sunday religious services? How about making it illegal to sell condoms in my community? When the hospital has the “monopoly” on care in an area, then I see their enforcement of their standards on others as no more superior morally and a violation of fundamental human rights.

  10. tgflux

    Fr William L, DO try to keep up.

    If you ever listen to EWTN, you’ll have learned that that type of Roman Catholic (the submissive-to-the-Pope-in-all-things tiny subset) in fact LOVES the term “Papist”: for that reason, I used to use it…

    …but then an online friend of mine, raised RC (she sometimes posts here, but I’ll leave to her to ID herself), objected (for historical reasons *) to “Papist.” Trying to find another word (that meant Papist/submissive-to-Pope-RC-tiny-subset), I tried several candidates. “Popoid” was one of those, and she (my friend) approved of it. It’s been my (accurate!) term ever since, and no, I’m not going to stop using it because you, “LA Episcopal priest” (O_o), object.

    * These historical reasons, are related to the irrational prejudice against ALL RCs, as exemplified by the Know-Nothings. Though I hardly need to justify myself (in this regard—God knows well enough I’m a sinner!), I have nothing but the GREATEST admiration for MOST Roman Catholics (e.g., in California, Roman Catholics had one of the HIGHEST rates of voting AGAINST PropH8).

    It’s only that tiny Popoid subset which retains those, ahem, Inquisitional tendencies (see re this thread). To put this in terms, Fr William, you may understand: Love the sinners—the Popoid sin can go back to the hell it came from!

  11. tgflux

    Ooops, that’s me, JC Fisher, above (but you knew that! ;-p)

    JC Fisher

  12. LA Episcopal priest

    Dr. Shy,

    I appreciate your reasoned and temperate response. — As for a specifically Anglo-Catholic take on the matter of the autonomy of Catholic hospitals I can only offer that an Anglo-Catholic has deep respect for the Catholic Church and its commitment to evangelization and works of mercy. — I trust you understand Catholic teaching on medical ethics. You probably also are aware that their is a breadth of reasoned and faithful opinion within the Catholic Church on the situation in Phoenix.

    But, of course, a reasoned discussion of Catholic moral theology governing specific scenarios in a Catholic institution is not where the contributors/ posters on this blog go. Rather, there is mainly an attack on the ability of Catholic institutions to carry out their corporate works of mercy consistent with the teachings of the Catholic (Christian) Faith. Further, there is an attack on the ability of individuals, Catholic and other Christians and no doubt non-Christians as well, to follow the dictates of their conscience while working in their vocation and providing a living for themselves and their families. To achieve a world where an abortion is readily available at a Catholic hospital there seems to be in these Episcopal Church circles no allowance for the integrity of the Church in its mission or for the integrity of nurses, doctors or others employed in the healing professions. It all seems very Soviet to me, this insistence by the vanguard that all institutions and individuals must submit to the will of the party/State. (Heaven?) forbid that the Church should have any ultimate authority other than the State. Isn’t it enough that you have liberty to follow your own consciences?

    I really don’t want to be a “culture warrior”; it is not my calling as a priest or as human being. But when even a forum of my church (can General Convention be far behind?) calls for the effective take over/confiscation of Catholic institutions and further suggests that individuals in non-church institutions have no right to not participate in the killing of another human being—abortion and euthanasia — I have to speak up. Following this trajectory, do you not realize that you or your children might also someday be stripped of your rights of conscience? Is it not possible that a doctor or nurse or pharmacist might also be forced to participate in infanticide, euthanasia of the handicapped or executions if the popular opinion and the state dictated so? If you have doubts, only look to modern Western history or to contemporary China.

    To all on this forum: remember that you are part of what was once the officially established church in much of America and establishment privilege continued long after the Church of England lost official status here. Consider how your attacks on the autonomy of the Catholic Church are inline with the historic societal oppression of Catholics and other non-Protestants. Consider how the hospitals you now attack were originally built by the toil and treasure of religious and ethnic minority immigrants who had the guts (and faithfulness to the Gospel) to build these institutions in the face of anti-Catholic bias and hatred. Remember that the Catholic Church in the South was years ahead of the Episcopal Church in recognizing the common humanity of whites and blacks and that outside of Louisiana the Catholic Church –and its people –was the second greatest target for Klan hatred.

    I just can’t imagine this kind of venom being spewed at Catholics in my earlier Episcopal Church settings where we had Canterbury and seminary retreats at Catholic monasteries, convents and retreat centers. I like to think that it was more than a veneer of graciousness that used to characterize Episcopalian-Catholic relations, but maybe not. In any case, I know I would rather stand with the Catholic Church and conscientious objectors of any faith against a majority that would strip them of their moral rights.

    Among my close (Roman) Catholic friends there is an angry to bewildered consensus against the actions of the bishop against the hospital. I take the part of the traditionalist in this circle of educated, involved, Democratic Party voting, gay and straight, Voice of the Faithful leaning, National Catholic Reporter and America reading Catholics. These are my kids’ godparents and my family’s closest friends. As much as these folks, including a theology department chairman and a chair of the ethics committee at a major LA non-Catholic hospital, disagree with many aspects of the current and last papacy, never would they think that the liberal Episcopalians they so like and admire from a distance have such a hatred for the Catholic Church.

    One more thing, folks– If you really can’t stand that Catholic hospitals will not perform abortions then get together with your co-believers and build your own clinics where you follow your own conscience.

    JC Fisher, The Know-Nothings weren’t irrational. They hated Catholics because they were a threat to the idea of a White Protestant America run by and for White Protestant Americans; they were simply following their reason when they burned Catholic schools, churches and convents. If the Catholics had just given up being Catholic . . . hey it’s all good! You offer an updated progressive SWPL version that would use the courts and legislation to accomplish the same ends of converting Catholic institutions to the progressive Protestant way of doing things or else shut them down. I am glad you ran your “Popoid” epithet by your focus group of one former Catholic. I recall that as a child I heard all kinds of rationalizations for using slurs; the old line about the slur not applying to the whole group rings a little hollow. But hey, pat yourself on the back for being magnanimous to your own sort.

    Fr. William Ledbetter

  13. tgflux

    A blessed New Year to you, Fr William.

    JC Fisher

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