Playing Catholic politics with US healthcare
A nun who authorised an abortion to save a mother's life was excommunicated. How will Catholic hospitals act in future?
Even though the Catholic hierarchy can take years to issue a reprimand against priests found to be guilty of sexual abuse, Sister Margaret McBride, a member of the ethics board at St Joseph's hospital in Phoenix, Arizona was reassigned and excommunicated in November 2009 after authorising an abortion in order to save the life of a 27-year-old mother of four. Bishop Thomas J Olmsted justified his actions by stating: "An unborn child is not a disease … the end does not justify the means." In December 2010, he stripped the hospital of its Catholic status, an ecclesiastical decision that renders the chapel unable to administer the eucharist.
St Joseph's hospital released a statement in support of McBride: "In this tragic case, the treatment necessary to save the mother's life required the termination of an 11-week pregnancy." A statement issued by Sr Carol Keehan, DC, president and chief executive office of the Catholic Health Association of the United States (CHA) concurred with this assessment: "They carefully evaluated the patient's situation and correctly applied the Ethical and Religious Directives for Catholic Health Care Services to it, saving the only life that was possible to save." Along those lines, America magazine, a national weekly Catholic magazine published by the Jesuits, ran two articles by a leading Catholic moral theologian, Kevin O'Rourke, a Dominican priest, which concluded that, according to church law, excommunication was not justified in this case.
However, the Catholic Medical Association (CMA) noted that this case "represents a significant step by a bishop to exercise his legitimate role as teacher and defender of the faith in his diocese as well as an unfortunate refusal of hospital officials to respect the bishop's role as a teacher and pastor". These contradictory statements need to be viewed in light of the fact that the CMA advances the doctrinal positions held by the US Conference of Catholic Bishops (USCCB) whereas the CHA, a trade organisation representing the business interests of Catholic hospitals, advocates to ensure that their member hospitals provide patient care for the entire community.
While this story may on the surface appear to be a specific diocesan dispute, currently there are 600 Catholic hospitals in the United States, comprising about one-fifth of all hospital beds. Also, about 45 Catholic hospitals in the US are sole providers, meaning they're the only hospital serving a community. As reported by The Revealer, a daily review of religion in the news and the news about religion, "these hospitals are governed by 72 ethical and religious directives that are written by the USCCB and enforced by the local bishop".
While Catholic hospitals receive about half of their funding from the Federal government via Medicare and Medicaid reimbursements, Catholic hospitals can claim exemption from federal laws through a web of "conscience" clauses. Ann Neumann, editor of the Revealer, observes: "In most Catholic health care facilities, the conscience of the church supersedes the rights of patients and individual doctors by limiting care services according to Catholic doctrine. Men, women, the elderly, the poor and the victimised – effectively, entire communities served by Catholic hospitals – suffer a drastic and often traumatic loss of patients' rights when information or services are denied, particularly when a Catholic hospital is the only game in town."
Bryan Cones, managing editor of US Catholic, a lay-edited national Catholic monthly magazine, places this debate within the larger framework of the ongoing discussion surrounding the intersection of Catholic faith and public healthcare in the United States. "The bishops in general and Olmsted in particular are insisting that their prudential judgment must be followed; that was the US bishops' position on the healthcare reform bill. I think it is unprecedented in the US Catholic church that the personal judgment of a bishop on a particular ethical situation has to be affirmed by a Catholic organisation or individual."
Catholics for Choice (CFC), an independent organisation that challenges the Catholic hierarchy on issues of human sexuality and reproduction, has been tracking healthcare in US-based Catholic hospitals since the early 1990s. According to the CFC president, Jon O'Brien: "Even though Olmsted is on the extreme end of how bishops enforce the 72 directives, it's significant that a Catholic hospital turned Olmsted down and are no longer considered to be Catholic. This hospital made a step in the right direction by showing that the bishop's stamp on their letterhead isn't as critical as providing services to the community."
Despite the fact that St Joseph's hospital is no longer considered Catholic, the staff continues to provide medical care following their interpretation of the directives. The question remains how other Catholic hospitals will respond when faced with a traditionalist bishop who overrides judgments made by trained medical personnel.
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