Last week Sierra Vista Hospital, in rural Southeast Arizona, abandoned its affiliation with the Catholic Carondelet Health Systems. One year into a 2-year trial period, reality apparently hit home. The hospital board could no longer ignore daily picketing by concerned citizens, growing discontent of physicians barred from delivering high quality medical care and mounting evidence that strict doctrinal enforcement undermines a community's trust in its medical provider. An informative PBS story (see the bottom of this post for the video) 4 days prior may have influenced board members as well.
Compassion & Choices supporters were especially concerned that end-of-life wishes be heeded and honored. Thus, we enthusiastically join Cochise Citizens for Patient Choice in celebrating this victory for quality care and patient self-determination. I hope this signals the start of a trend among hospitals to avoid mergers binding them to religious doctrine.
Over the last century Catholic institutions grew, prospered and assumed an ever greater market share in the healthcare industry. Today more than 600 Catholic hospitals deliver care to 1 in 6 patients in the United States each year. Since 1971 these hospitals have followed written doctrinal direction from the National Conference of Catholic Bishops, which in turn follows the Vatican.
A publication called Ethical and Religious Directives for Catholic Healthcare (ERD) lays it all out. Until recently hospitals could interpret the ERD according to their own conscience, and they usually found ways to meet the needs and expectations of their communities. But the local bishop is final decision-maker and an increasingly conservative hierarchy is flexing its doctrinal muscle across the nation. This leaves hospitals with a stark choice: buckle under pressure from Catholic authority or break the shackles of Vatican oversight.
The tension plays out in different ways.
Last May, Bishop Olmstead of Phoenix terminated the church's 116-year relationship with St. Joseph's Hospital for terminating a woman's pregnancy to save her life. The hospital, its parent corporation, Catholic Healthcare West, and the Catholic Health Association all backed the decision of Sister Margaret McBride, who led the hospital's ethics committee. Now she is excommunicated, Mass no longer occurs in the hospital chapel, and the community knows its hospital will not allow Bishop Olmstead to obstruct a life-saving procedure.
Similarly, St. Charles hospital in Bend, Oregon, refused to accede to demands from Bishop Robert Vasa to stop performing tubal ligations for women seeking to limit their pregnancies. Founded by nuns 92 years ago, St. Charles is no longer a Catholic health center and delivers about 250 tubal ligation services per year.
But in Texas, Bishop Alvara Carrada stopped tubal ligations at St. Michael's and Trinity Mother Frances Hospital in 2009. Now women who give birth there by caesarean section must endure the risks and inconvenience of a second surgery, at a different facility, to have their tubes tied. Exposing patients to unnecessary surgical risk falls below the standard of care in every community.
For Compassion & Choices, the chief hazard of the ERDs is the stipulation that advance directives are valid so long as their instruction does not conflict with Catholic teaching. Since the local bishop interprets and enforces Catholic teaching, it's uncertain how a person's wishes might be viewed should the need arise. Compassion & Choices offers a Dementia Provision as an advance directive addendum, and it seems almost certain to run afoul of recent Catholic teaching on tube feeding.
Catholic dogma and community medical expectations are on a collision course. Hospitals serving diverse communities cannot shoulder the weight of strict ERD enforcement as America's population ages and vests itself in end-of-life choice and control, as new technologies to treat infertility emerge and as therapies developed with embryonic stem cell cultures come on line.
To me, the most striking aspect of these events is how totally tone deaf Catholic leaders are to growing disenchantment with their edicts. They care not at all that Catholic hospitals deliver healthcare to Lutherans, Presbyterians, Jews, Muslims, Buddhists and Atheists as well as Catholics. They demand Catholic doctrinal adherence from all.
Catholicism's place in American society has changed dramatically over the past twenty-five years. The hierarchy has exaggerated its political power by extracting obedience from Catholic elected officials and controlling their votes. But the criminal cover-ups and harboring of public menaces have decimated its moral authority.
The PBS story features Bishop Weinandy, executive director for the Secretariat of Doctrine, and Richard Dorflinger, Associate Director, Secretariat of Pro-Life Activities, both at the U.S. Conference of Catholic Bishops. Weinandy defends Bishop Olmstead's preference for a woman's death over a pregnancy termination with this: "If you directly said the mother could not live unless we aborted the child then that would be contrary to Gospel values and the teaching of the church."
That may be a reason enough for Weinandy and Dorflinger, but it shocks the conscience of most Americans and conflicts with their expectations for responsible health care. The Washington Post offers an example from the ranks of Catholic moral theologians. It cites Rev. James Bretzke of Boston College, "who supports the directives but said he might now hesitate if a female relative sought some care at a Catholic hospital."
When Reverend Bretzke's hesitation spreads to a critical mass of alert healthcare consumers, as it did in Sierra Vista, I predict Catholic healthcare institutions will do the right thing. In increasing numbers they will reject their assigned role as enforcer of Vatican doctrinal ideology, and serve their communities instead. If not, purchasers of healthcare --- patients, employers and insurance carriers --- will shun them in the marketplace, preferring providers unencumbered by obedience to dogma that harms patients.