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Legislative restrictions to family planning services aren’t the only threat to reproductive healthcare in America today. One area of increasing concern, as highlighted in a recent segment of Samantha Bee’s Full Frontal, is the growing number of Catholic owned or affiliated hospitals.
Many hospitals in the U.S. are in financial straits. As a result, some are opting to merge with better funded religiously affiliated hospitals (which receive billions in taxpayer dollars annually). As a condition of the merger, the previously secular hospitals often must agree to abide by the religious tenets of the hospital they are merging with. All Catholic owned and affiliated hospitals must abide by the Ethical and Religious Directives for Catholic Health Care Services (“the Directives”) set forth by the U.S. Conference of Catholic Bishops. The Directives prohibit a range of reproductive healthcare services, including contraception, sterilization, emergency contraception for pregnant rape victims, many fertility treatments, and abortion care, even in instances when the pregnant person’s life is in jeopardy (see Appendix B for relevant sections).
The number of Catholic affiliated hospitals in the U.S. has increased by 22% since 2001. According to a report released by the American Civil Liberties Union (ACLU) and MergerWatch, 1 in 6 hospital beds are located inside a facility that complies with the Directives. In some states, as many as 40% of all hospital beds are within a Catholic-run facility and in some regions of the country a patient may have to travel for hours to reach a non-Catholic hospital. Furthermore, the nearest non-Catholic facility may not be covered under a person’s insurance plan. The prevalence of Catholic hospitals poses significant challenges for many in need of reproductive healthcare, but especially for individuals who are in a life threatening situation.
Although only a small percentage of abortions are performed in hospitals, the ones that are often are in situations in which the pregnant person is in grave physical risk, such as a miscarriage which is progressing too slowly. If someone begins miscarrying, clearing out the fetal tissue can be an essential step in keeping the pregnant person from contracting a life-threatening infection. However, at a Catholic facility, as long as the fetus’s heart is beating, healthcare providers are expected to do everything possible to keep from ending the nonviable pregnancy prematurely, even if doing so could seriously injure or kill the pregnant person.
The ACLU report and Samantha Bee’s interviews contain numerous heartrending stories from patients and physicians alike about the adverse effects the Directives have had on women in already dire circumstances. Doctors at Catholic facilities have reported having to turn away miscarrying patients with soaring fevers because the hospital would not let them perform the necessary abortion. A doctor at a non-Catholic facility recalled caring for a patient who had been sent away from a Catholic facility. By the time she reached his hospital, her fever had climbed to 106° F and she was undergoing sepsis (the same condition which killed Savita Halappanavar). The patient “suffered an acute kidney injury requiring dialysis and a cognitive injury due to the severity of her sepsis” and spent nearly two weeks in the hospital before she was released to a long term care facility.
When Catholic hospitals do intervene to save the life of a pregnant person, there can be severe consequences imposed by Catholic religious authorities. In 2009, St. Joseph’s Hospital and Medical Center in Phoenix, Arizona deemed that an abortion was the only way to save the life of a patient at serious risk of dying from heart failure. The hospital was subsequently stripped of their Catholic affiliation for approving the abortion. Additionally, the nun who gave the approval, Sister Margaret McBride, was excommunicated for her role in the procedure. Following the controversy, the U.S. Conference of Catholic Bishops clarified the Directives, stating “[d]irect abortion is never morally permissible . . . no matter what the reason.”
Catholic hospitals also create hardships for individuals who give birth in their facilities. Tubal ligations are prohibited by the Directives, even when the pregnant person would likely die were they to become pregnant again. If a patient is undergoing a Caesarian and needs a tubal ligation, it is much safer to perform the tubal ligation immediately following the delivery rather than perform a separate surgery at a later date. Requiring a second surgery not only jeopardizes a patient’s health, but also means that she will have to find an entirely different hospital that is covered by her insurance at which to have the procedure, a task that is impossible for some.
The above examples are some of the more extreme outcomes stemming from the rise in Catholic hospitals, but there are many other obstacles to reproductive healthcare at Catholic facilities as well. Physicians cannot provide their patients with contraception, which millions of people rely on to keep from becoming pregnant in the first place. Medical practitioners are only supposed to discuss so-called “natural family planning” with married patients; unmarried patients are not to receive any pregnancy prevention counseling. Gynecologists have even been prohibited from removing dislodged non-hormonal IUDs due to the IUD’s role in facilitating pregnancy prevention. Any fertility treatments which separate conception from sex are prohibited, which includes in vitro fertilization, artificial insemination, and any procedure using donor sperm or eggs.
Federal law prohibits some of the most egregious practices of Catholic hospitals, such as transporting patients in unstable condition, as is the case for many suffering from an infection as a result of miscarriage (see Appendix D). However, even with mounting stories of negligence, few hospitals face any consequences for their dangerous practices. In fact, nearly a dozen states have laws which make it more difficult to hold religious hospitals liable for the harm they cause (see Appendix C). It’s time to change the laws, both at the state level and at the federal level to hold Catholic hospitals accountable, as well as work to prevent further hospital mergers. Reproductive healthcare is fundamental to an individual’s wellbeing, and no one should be denied essential care due to someone else’s religious affiliation.