Bishops revise Catholic health care
directives
By PATRICK ONEILL
Special to the National Catholic Reporter
Catholic health care in the United States predates the formation
of the Union, but only in recent years has this vast network of Catholic
hospitals run into the problems commonly associated with free-market health
care.
Increasingly, once-independent Catholic hospitals, seeking relief
from financial pressures, are affiliating with nonsectarian institutions --
affiliations that often require compromises related to the churchs
teaching on sexual ethics. New health care partners often dont agree with
the churchs bans on sterilization and abortion, and the pressures of the
market can be difficult to reconcile with church teaching.
Some of the recent arrangements have commanded the attention of
the Vaticans Congregation for the Doctrine of the Faith, which
essentially takes a no-compromise stance when it comes to Catholic teachings on
sexual ethics.
Now, with an eye to closing loopholes that might have given
ethicists and bishops wiggle room in striking deals, U.S. bishops, under
Vatican scrutiny, have been revising the language in their Ethical and
Religious Directives for Catholic Health Care Services.
The U.S. bishops have received a fourth draft of the proposed
revision -- already approved by the Vatican -- and they are expected to vote on
new language for the directives when they meet in Atlanta June 14-16.
Among creative solutions that were devised previously,
causing the recent revision of the directives by the bishops, sterilization
referrals were sometimes made to a unit of the hospital that was under separate
control from the main Catholic hospital. In such cases -- and in
others, where sterilizations might even be done within a Catholic institution
-- ethicists and bishops have drawn their arguments from the principle of
cooperation in instances of duress.
Notre Dame law professor Cathleen [Kaveney] says the
directives will help provide guidance when Catholic and non-Catholic
institutions affiliate. A key point being articulated in the directives is
how close you can get to a wrongful act performed by somebody else,
[Kaveney] said. The directives are clear, says
[Kaveney] -- Catholics cannot justify immediate material
cooperation with sterilization, abortion or euthanasia. However,
[Kaveney] says two hospitals can affiliate and still maintain
some of their distinctness.
Corporate law is flexible enough to allow that,
[Kaveney] said. So you can have a system that includes a
Catholic hospital thats still a Catholic hospital and a non-Catholic
hospital within the same system, not necessarily within the same
building. Where patients are concerned, the argument goes, to ban
sterilizations completely could threaten the health of some patients,
particularly where access to health care is limited. Where institutions are
concerned, an overly rigid approach to mergers could threaten survival of
Catholic health care in a community.
Fr. Michael Place, president of the Catholic Health Association,
said the revised directives more specifically define limits for Catholics
working in newly merged facilities.
We needed some direction with regard to how we proceeded
when weve entered into arrangements with folks who do not share all of
our values, Place said.
At the heart of the matter right now is the question of
sterilization, said Bishop Donald Wuerl, one of the contributors to the
revised directives. How involved can a Catholic health care institution
be in any institution or structure that provides sterilization? he asked
in an interview.
Abortion and euthanasia are already clearly ruled out
because the directives were much more precise in dealing with those. The
directives say under no circumstances can abortion be tolerated in Catholic
hospitals -- even using the principle of material cooperation. And now the
question is to make the same clear, categorical prohibition against
sterilization, against direct sterilization.
The Holy See is reminding all of us that direct
sterilization is immoral, and a Catholic cannot be involved in that
procedure, Wuerl, bishop of Pittsburgh, said.
Regardless of how narrowly Catholic health care directives are
written, interpretation of the rules will remain in the hands of the local
bishop, Wuerl said.
For many in Catholic health care, though, including many moral
theologians, it is unfortunate to write rules for health care that suggest
sterilization and abortion are evils of the same magnitude.
Said [Kaveney]: I dont think that there
is any effort to say that sterilization and abortion and euthanasia are wrongs
of the same seriousness. I think thats clearly not meant to be said. But
what they are saying is that the principle of material cooperation with evil
cant be used to justify Catholic hospitals performing any of these acts.
... Theyre making things a bit more stringent with respect to
sterilization.
Also keeping an eye on developments is MergerWatch, an Albany,
N.Y.-based group that claims to monitor threats to reproductive health
care and patients rights.
Its been our hope that the use of these creative
solutions to continue reproductive services at non-Catholic hospitals could be
actually expanded, not restricted, said Louis Uttley, MergerWatch
director. We are very concerned about any action the bishops might take
which would make it more difficult to preserve access to services at
non-Catholic hospitals when they form business partnerships with Catholic
facilities.
Groups such as MergerWatch say theyre particularly concerned
about hospitals in rural areas that come under Catholic control. These places
may be the only facilities for miles offering birth control options and/or
abortions.
On the other hand, Msgr. Dennis Regan, vice president for mission
and ethics at Catholic Health Services of Long Island, said Catholic
institutions must be wary of what some term creative solutions that
could jeopardize Catholic identity.
Catholic Health Services of Long Island oversees Catholic health
care facilities in the Rockville Center, N.Y, diocese, all of which are
operated by the diocese.
Partnerships with non-Catholic entities are necessary and often
very complex, Regan said, but creative solutions can result in
Catholics in reality or in appearance lacking integrity or talking out of
both sides of our mouths.
Said Uttley: We certainly understand the financial reason
why hospitals are looking to affiliate and merge, including Catholic hospitals,
but we dont feel that these mergers should be allowed to impose one
religions beliefs about health care on nonsectarian hospitals which serve
the whole community.
The strongest critics of Catholic health care directives are
affiliated with a loose coalition of groups that back abortion rights, said
Place of the Catholic Health Association. Their focus is not just the
mergers, he said. Their goal, stated several times, is every
Catholic hospital, merged, unmerged, should be to required to provide abortions
and sterilizations. Thats where theyre going with this.
I dont know of anyone raising these objections to
particular mergers who is not associated with the pro-abortion agenda, he
said.
Professional groups have also become involved.
Last November, the American Public Health Association recommended
more government oversight of mergers to protect reproductive health services.
Conversely, last June, the American Medical Association passed a resolution
reiterating support for hospitals that restrict certain services for moral
reasons.
Sometimes lost in the debates over the directives is the enormous
contributions Catholic health care provides nationally, Place said.
Catholic health care is the largest single aggregate within the
not-for-profit sphere of health care delivery in the United States, Place
said. And we are there because of our commitment to the well-being of
individuals, most particularly to those who are vulnerable and in need.
We believe that its a pluralistic society, that we
have had a historic covenant in this country that has given the space within
the voluntary sector for faith-based organizations to do social good in a
manner thats consistent with their own values.
Regan of Catholic Health Services of Long Island said good
intentions and a desire to preserve Catholic health care are the primary
motivating factors behind seeking creative solutions. I am not judgmental
about their efforts to try and work out [compromises that] respect some of the
other peoples values, he said. In some cases it worked. Other
cases it went a little too far.
Thats not surprising. This entire industry is in an
incredible state of flux, and changing, sometimes not even daily, but from
morning to afternoon, he said.
The challenge, said Wuerl, is to maintain theological integrity in
the face of that dynamic.
Thats the challenge of being Catholic, he said.
Its true of Catholic health care. Its true of Catholic
education. Its true of Catholic charities. Its true of Catholic
social service ministry. What we bring to the market is our faith, our gospel
values, our conviction that were doing this out of the love of Jesus
Christ. .... We will be different because of that, and were going to run
into difficulties because of that, but thats who we are and thats
why Catholic identity drives Catholic health care.
National Catholic Reporter, June 1, 2001
[corrected 06/15/2001]
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