How Ethical Are These Directives?

Since I put up yesterday’s post about the Catholic hospital telling nearly all of the OB-GYNs in town that they can no longer prescribe birth control, I’ve been told that this is, in fact, illegal. Ophelia confirms that the Freedom From Religion Foundation and American Atheists are both looking into this matter. Step one, which is hard to do on a Sunday, is to confirm that Ascension Health really intended to give Bartlesville OB-GYNs this message and intends to stand by this now that it’s received some publicity–that it’s neither a miscommunication nor a “miscommunication”. I’ll update here or in a separate post as I hear more.

Meanwhile, via Mano (and Pteryxx) comes the news of a probably doomed lawsuit against the U.S. Conference of Catholic Bishops over the same Ethical And Religious Directives for Catholic Healthcare Services (pdf) that is in play in the Ascension Health situation. The impetus for the lawsuit is a case very much like Savita Halappanavar’s but not resulting in death. In this case, however, the patient was not even given enough information to ask for her miscarrying fetus to be aborted to protect her health.

While the article at ProPublica indicates that the lawsuit may not hold up, it also highlights how big a problem we’re looking at.

The ACLU and women’s groups have been voicing concern since the 1990s about the growing role of Catholic health care operations around the country and what they see as the resulting threats posed to women’s reproductive rights. Those complaints have grown louder in recent years as Catholic facilities have moved aggressively to merge with secular hospitals and reports have surfaced about the challenges – some say contortions — that doctors and nurses have sometimes had to face to comply with church teachings on abortion, birth control, and end-of-life care while fulfilling their duty to patients.

Catholic hospitals now account for about 16 percent of hospital beds in the U.S. And in eight states — including Washington, Oregon, Iowa, and Missouri — they control more than 30 percent of beds. Ten of the 25 largest health-care networks in the country are Catholic-sponsored.

That’s an awful lot of people subject to those Ethical And Religious Directives, and frequently without another reasonable choice. An awful lot of those beds are in more isolated communities like Bartlesville, making the next-nearest hospital both far away and likely to itself be a Catholic hospital. That makes this statement from the Ethical And Religious Directives even more absurd.

When the health care professional and the patient use institutional Catholic health care, they also accept its public commitment to the Church’s understanding of and witness to the dignity of the human person.

People don’t have other real options, and they’re not being asked to affirmatively make an educated choice about this matter. It’s being aggressively pushed on them and spread to more and more hospitals. Their acceptance comes not by choice but by declaration of the bishops.

So what are people “accepting” when their local hospital gets bought out or merged? Here are some of the directives.

4. A Catholic health care institution, especially a teaching hospital, will promote medical research consistent with its mission of providing health care and with concern for the responsible stewardship of health care resources. Such medical research must adhere to Catholic moral principles.

This means that the Conference of Catholic Bishops is determining what kinds of research may be done in this country and largely excluding rural populations from certain kinds of research.

5. Catholic health care services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives for administration, medical and nursing staff, and other personnel.

Despite the fact that some of these requirements for privileges are against the law, as already discussed, they are official policy–without an exemption for those requirements that are illegal.

7. A Catholic health care institution must treat its employees respectfully and justly. This responsibility includes: equal employment opportunities for anyone qualified for the task, irrespective of a person’s race, sex, age, national origin, or disability; a workplace that promotes employee participation; a work environment that ensures employee safety and well-being; just compensation and benefits; and recognition of the rights of employees to organize and bargain collectively without prejudice to the common good.

What’s important here is what isn’t included. Discrimination on the basis of sexual orientation or gender identity may be considered to be not only not prohibited, but required where it isn’t otherwise prohibited by law.

13. Particular care should be taken to provide and to publicize opportunities for patients or residents to receive the sacrament of Penance.

Oh, hai. I know you’re all bleeding and stuff, but I just thought I should remind you that the Church considers you a sinner.

24. In compliance with federal law, a Catholic health care institution will make available to patients information about their rights, under the laws of their state, to make an advance directive for their medical treatment. The institution, however, will not honor an advance directive that is contrary to Catholic teaching. If the advance directive conflicts with Catholic teaching, an explanation should be provided as to why the directive cannot be honored.

You have a right to direct your medical care. We have the right to ignore you.

25. Each person may identify in advance a representative to make health care decisions as his or her surrogate in the event that the person loses the capacity to make health care decisions. Decisions by the designated surrogate should be faithful to Catholic moral principles and to the person’s intentions and values, or if the person’s intentions are unknown, to the person’s best interests. In the event that an advance directive is not executed, those who are in a position to know best the patient’s wishes — usually family members and loved ones — should participate in the treatment decisions for the person who has lost the capacity to make health care decisions.

You have the right to appoint some to advocate for the Church first and you second.

26. The free and informed consent of the person or the person’s surrogate is required for medical treatments and procedures, except in an emergency situation when consent cannot be obtained and there is no indication that the patient would refuse consent to the treatment.

It is not, however, required for any of these directives. They’re just part of the package.

27. Free and informed consent requires that the person or the person’s surrogate receive all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all.

We don’t, however, have to tell you anything about what the standard of care would be if you were transferred to a non-Catholic hospital. That’s not required for “free and informed consent”.

29. All persons served by Catholic health care have the right and duty to protect and preserve their bodily and functional integrity. The functional integrity of the person may be sacrificed to maintain the health or life of the person when no other morally permissible means is available.

“Bodily integrity” will also be used to deny care to those with gender dysphoria, as Zinnia pointed out on Twitter today.

36. Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials and offer the person psychological and spiritual support as well as accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.

Feel the compassion.

38. When the marital act of sexual intercourse is not able to attain its procreative purpose, assistance that does not separate the unitive and procreative ends of the act, and does not substitute for the marital act itself, may be used to help married couples conceive.

If you’re unmarried, forget it. If you’re married to someone of the same sex, forget it. If you need to take the egg and sperm out of either of your bodies in order to properly introduce them, forget it. If you need a donor for anything, forget it. The next several directives spell out many of these directly. The others are unthinkable and/or unprintable.

43. A Catholic health care institution that provides treatment for in fertility should offer not only technical assistance to infertile couples but also should help couples pursue other solutions (e.g., counseling, adoption).

Now that we’ve created this little problem for you, I guess we should help you not solve it as well as possible.

45. Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.

What does “sole immediate effect” mean? It’s not just a semantic question. It’s at the heart of miscarriage issues like Savita’s death and the ACLU case above. If preventing sepsis is “immediate”, so is preventing many of the effects of advancing pregnancy. However, people are sanctioned by church and hospital system for performing or even counseling other kinds of therapeutic abortions. It’s no wonder at all that people die because of this provision. This is a scientifically and philosophically incoherent statement that kills and injures.

And fuck your “scandal” if you’d rather be associated with malpractice like that than with people who offer clean and safe abortions.

47. Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.

Here “direct purpose” is allowed. Direct termination still isn’t, though, so enjoy the moral superiority that somehow is supposed to come from the slow death of your fetus.

48. In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.

A little light reading on “extrauterine pregnancy”. If you don’t want to click through, the key phrase is “high maternal and fetal morbidity and mortality”. This restriction means you have to already be in acute trouble before your doctor will act.

50. Prenatal diagnosis is permitted when the procedure does not threaten the life or physical integrity of the unborn child or the mother and does not subject them to disproportionate risks; when the diagnosis can provide information to guide preventative care for the mother or pre- or postnatal care for the child; and when the parents, or at least the mother, give free and informed consent. Prenatal diagnosis is not permitted when undertaken with the intention of aborting an unborn child with a serious defect.

If you would abort if presented with bad news, you will not be allowed to know.

52. 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.

Not married? Start a pregnancy in complete ignorance.

53. Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.

Have a family history of ovarian cancer? Carry a gene that makes it likely the same will happen to you? Aw, shucks.

55. Catholic health care institutions offering care to persons in danger of death from illness, accident, advanced age, or similar condition should provide them with appropriate opportunities to prepare for death. Persons in danger of death should be provided with whatever information is necessary to help them understand their condition and have the opportunity to discuss their condition with their family members and care providers. They should also be offered the appropriate medical information that would make it possible to address the morally legitimate choices available to them. They should be provided the spiritual support as well as the opportunity to receive the sacraments in order to prepare well for death.

Even when you’ll die without it, though, we won’t tell you about the existence of any treatment we don’t like.

58. In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the “persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care. Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be “excessively burdensome for the patient or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed.” For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.

Your cerebral cortex may have turned to inert jelly, but we won’t unplug you. You may be terminally ill and in uncontrollable pain, but we’ll keep you going.

60. Euthanasia is an action or omission that of itself or by intention causes death in order to alleviate suffering. Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way. Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death.

It is very dignified to beg for the relief of death and be treated as an immoral child.

Picture of a crucifix with a gaunt, agonized Jesus.
If it’s good enough for this divine being, we don’t see why we shouldn’t demand it of mere mortals.

61. Patients should be kept as free of pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die. Since a person has the right to prepare for his or her death while fully conscious, he or she should not be deprived of consciousness without a compelling reason. Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death. Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.

Excuse me, an immoral child who is being lectured to.

66. Catholic health care institutions should not make use of human tissue obtained by direct abortions even for research and therapeutic purposes.

Because what the opposition to abortion is really about is protecting life.

67. Decisions that may lead to serious consequences for the identity or reputation of Catholic health care services, or entail the high risk of scandal, should be made in consultation with the diocesan bishop or his health care liaison.

There was a directive toward the beginning of this document that I rather liked. It had to do with serving the people in the margins of society. I guess that doesn’t apply if those people might somehow be scandalous.

All that is what we “accept” if we work for or receive our help care from Catholic-owned institutions. None of it is acceptable to me. I’m lucky, though. My big local hospital network isn’t Catholic. I can scream about it if they try to merge or sell to a Catholic system, with a good chance of being effective. That doesn’t mean there aren’t plenty of Catholic hospitals here, some of them in small communities like Bartlesville. Their patients are just as vulnerable to having to “accept” all of these.

What do we do about them?

Image: “Crucifix in the hall” by John Ragai. Some rights reserved.

How Ethical Are These Directives?

9 thoughts on “How Ethical Are These Directives?

  1. 1

    I hate the nonsense argument that people are actually choosing Catholic health care facilities; their whole motivation in these mergers is to remove choice so that people are stuck with them.

  2. 2

    There’s another notable absense from Directive 7: religion.

    7. A Catholic health care institution must treat its employees respectfully and justly. This responsibility includes: equal employment opportunities for anyone qualified for the task, irrespective of a person’s race, sex, age, national origin, or disability; a workplace that promotes employee participation; a work environment that ensures employee safety and well-being; just compensation and benefits; and recognition of the rights of employees to organize and bargain collectively without prejudice to the common good.

    It seems like, as Catholic healthcare becomes more and more dominant, that will be even more of a problem, and not just for those on the atheist and agnostic end.

  3. 4

    What “redemptive suffering”? I’ve never found suffering redemptive. It tends to move me even further from any form whatsoever of redemption.

    I lived in a small community as a child with only a Catholic hospital. While I was waiting for emergency surgery, the sweet good little Catholic nurse who was trying to prep me was so ignorant of what went on “down there” that she was completely unable to place a catheter! It’s not like she didn’t have the same parts herself or didn’t use them. Getting away from that hospital was the one good thing when the family moved to the big city.

  4. 5

    Never gonna happen, but the government should pass a federal law prohibiting churches from buying hospitals in areas where there are no secular alternatives, unless that church agrees to operate the hospital by secular ethics. Hm. Since we know the motherfucking shitbag torture lovers can’t be trusted to meet the last requirement, maybe that stipulation can just be left out.

  5. 6

    Speaking of the effect Catholic hospitals are having on the community, you might be interested in this article, which appeared in The Stranger (an alternative weekly in Seattle) a year ago: Faith Healers: Catholics Are Taking Over Local Hospitals, Imposing Their Faith on Your Health Care, and Planning to Deny Certain Treatments for Patients Who Are Pregnant or Dying

    In Washington State, it goes beyond abortion: we have a “right to die” law, and Catholic hospitals are refusing to tell patients or their families about their rights, and refusing to allow patients to claim those rights.

  6. 7

    Can Mr. Smith visit Washington, propose and pass a law that states:

    “Any hospital receiving Federal funding must provide care as medically proscribed and determined [I am forgetting the correct terminology] by scientific literature. Failure to follow and provide medically proscribed procedures will be a violation of Civil Rights and punishable by prison times, fines, and civil fines.”

    Of course, that assume that we have politicans in government that actually care about the invidivudal and not the next reection cycle of their party.

  7. 9

    You’re missing one of the more interesting “you chose …” parts: these are teaching hospitals, and residencies are not optional. Every year there’s a nationwide “Match” which places shiny new MDs at teaching hospitals. “I am not Catholic and do not choose to be subjected to Catholic doctrine in the practice of medicine” is not one of the factors in placing residents.

    Might want to have a chat with Dr. Gorski and others on that one.

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