When the devastating Dobbs decision was handed down by the Supreme Court in late June, Americans across the country — a large majority of whom support Roe v. Wade – felt a collective wave of rage, frustration and fear. The concern was, undeniably, deepest in states with trigger laws, where a wave of draconian restrictions has already unfolded. But wherever you live, whether your condition is currently red or blue, there is another growing barrier to accessing abortion and comprehensive gynecological services. It is the Catholic Church.
Anyone familiar with the way Catholic church records would not be surprised that the Ethical and Religious Guidelines of the United States Conference of Catholic Bishops (ERD) prohibit abortion and contraception – among other services like confirmation treatment for sex, most fertility treatments and medical assistance in dying – in a Catholic hospital. But Catholic doctrine is becoming a really big deal in more subtle ways — in its ever-expanding role in American health care and in the confusing and contradictory execution of religious dogma in medical options that can put patients at risk to their lives. unknowing.
Your own local hospital may take inspiration from the Vatican, and you may not know it.
“Catholic health care is now collectively the largest nonprofit, nongovernmental, health care provider in the United States,” said Jason T. Eberl, Ph.D., director of the Albert Gnaegi Center for Ethics. health care at St. Louis University. , told me in a recent phone conversation. “In fact, my understanding is, in the world.”
The Catholic Health Association reports that in 2022, it represents 654 hospitals across the United States, including 299 that provide obstetrics services. And if a patient isn’t seeking services that conflict with DREs, then having more health care services in more places can be a win, especially for residents of rural and underserved communities. But if you’re one of the half of the population for whom the possibility or reality of pregnancy has ever presented itself in your life, know that the United States Conference of Catholic Bishops has a lot to say about your care.
In some areas, Catholic facilities are the only community hospitals, including areas of California, Colorado, and Illinois. People who might otherwise think their reproductive options are safe because they live in a blue state may eventually find that privilege may depend on how far they can drive. And with nearly 900 hospitals across the country at risk of closing, most in rural areas, the journey could be a very long one.
Four of the country’s 10 largest health systems are Catholic. They are all beholden to these ethical and religious guidelines. Your own local hospital may take inspiration from the Vatican, and you may not know it. As a 2020 Community Catalyst report on the growth of Catholic health care systems titled “Growing Bigger” explains, “Historically Catholic hospitals that were purchased by for-profit systems can still track Catholic DREs [Ethical and Religious Directives] as a condition of sale. Non-Catholic, not-for-profit hospitals that have merged with Catholic facilities are often required to adopt all or part of the DREs. Public hospitals that are run by Catholic health systems may have agreed to eliminate all services that conflict with DREs. »
Where this becomes particularly thorny for pregnant patients is this guideline: “No intervention is morally lawful that constitutes a direct abortion. Any intervention whose only 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.
The vaguely positive news for patients with an ectopic pregnancy or a large tumor is that a Catholic doctrine known as double effect allows patients to receive lifesaving treatment and surgery as long as death of the fetus is just an unintended consequence of the procedure. Patients should also, if they have had a miscarriage, be able to obtain the appropriate procedure or medication to expel the fetal remains.
The bad news is that in a crisis, patients may not be able to convince anyone to take the risk of performing the procedure. It’s not just Catholic facilities either. In 2018, Walgreens pharmacist Nicole Mone Arteaga, an Arizona woman, refused to fill a prescription for medication after her miscarriage, citing her “ethical beliefs”. Now, after Dobbs, health care advocates fear it will become more common practice. Texas physician Dr. Lauren Thaxton recently told NPR that she has heard of miscarriage patients who cannot get their misoprostol prescriptions filled.
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Patients with ectopic pregnancies share similar risks. In Missouri, treatments are said to be delayed because the state’s trigger law only allows abortion if there is “serious risk of substantial and irreversible physical impairment.” In other words, doctors can feel comfortable waiting to help patients until they are in a life-threatening emergency.
So while Jason Eberl said “Dobbs shouldn’t change anything” about the way Catholic health care is administered, when I tell him I’m afraid Catholic health care workers are now more reluctant to provide certain care, even in permitted circumstances, he replied, “I share that fear.”
The medical history of the Catholic Church here certainly confirms these apprehensions. Ireland’s long-standing push for reproductive rights was propelled in large part by the 2012 death of Savita Halappanavar, a pregnant Galway woman who was denied proper intervention when she developed sepsis. during a miscarriage, as hospital staff informed her, “this is a Catholic country.”
And it’s not just overseas. A 2008 report in the American Journal of Medical Health found that “American obstetrician-gynecologists working in Catholic-owned hospitals have revealed that they are limited in the management of miscarriages…Some physicians have intentionally violated the protocol because they felt that patient safety was compromised”.
In 2011, the ACLU released a report titled “The Growth of Catholic Hospitals and the Threat to Reproductive Health Care,” highlighting case studies of women being denied proper care for miscarriage or birth. not being informed of their risks. In 2016, the Guardian published the findings of former Muskegon County, Michigan health official Faith Groesbeck, who accused Mercy Health Partners of “forcing five women between August 2009 and December 2010 to undergo dangerous miscarriages by giving them no other choice… In every incident, [Mercy Health Partners] denied medically indicated treatment and information to pregnant women facing emergency situations”.
And patients may not be aware of this potential harm until it’s too late, as the fact that their care options are being dictated by a team of bishops may not be apparent. Catholic guidelines state that “Catholic health facilities should not provide abortion services, even on the basis of the principle of material cooperation. In this context, Catholic health care institutions must be concerned about the danger of scandal in any association with abortion providers.
Patients may not know until it is too late, as the fact that their care options are being dictated by a team of bishops may not be apparent.
Thus, a search for “abortion” on the site of the Catholic health system Ascension redirects gently to “ablation”. And even though they promote among their obstetric services “advanced care for high-risk pregnancies”, they do not mention that a high-risk patient could not have an abortion if necessary. A search for Catholic Dignity Health System returns almost identical results. Emails to Ascension and the Catholic Health System this week went unanswered. In a brief phone call to a Dignity Birthing Center, the person answering the phone said, “I’d like to talk, but I’m not allowed to,” before wishing me a have a good day.
The lack of transparency does not seem unintentional. As the New York Times reported in 2018, after reviewing the websites of 652 U.S. Catholic hospitals, “Nearly two-thirds of them took more than three clicks from the home page to determine that the hospital was Catholic Only 17 individual Catholic hospital websites, less than 3%, contained an easy-to-find list of services not offered for religious reasons.”
It’s not just abortion on demand. This is the impact on the health and safety of pregnant women. It is about the utter absurdity of a group of religious men making great strides in the practice of American medicine, and the increasingly prolific aggressive interpretation of their guidelines. It’s about what could easily happen to you, or someone you love, in a dire medical situation, where your doctors take their cues about your care not from what’s going on in your body, but from what that the bishops decided to be the best.
Even for practicing Catholics, this should be frightening. “I fear Dobbs is crossing paths with a phenomenon that we already have among Catholic and Christian and even non-religious pro-life doctors or pharmacists or other healthcare workers,” Jason Eberl said. “Being too scrupulous about their valuing of embryonic and fetal life, and occluding respect, valuing the life of the pregnant patient before them.”
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