Case 1. A couple walks into Sherman Hospital seeking to schedule a vasectomy for the male partner, a procedure that can take up to 30 minutes, costs up to $1,000, and can prevent the couple from having their sixth child. The couple gets convinced that the female should get a hysterectomy instead, a procedure that takes up to two hours, is performed under general anesthesia, and costs four to eight times as much as a vasectomy. Little did they know that Sherman Hospital was a Catholic-based hospital.
Case 2. Let's do another one, this is fun. A female walked into her university's clinic hoping to get prescribed birth control. With an "Adoption is an Option" poster hung on the wall behind the doctor, the female student heard that she cannot be prescribed oral contraception, nor receive any type of birth control. She was reminded that "Abstinence is the best way to prevent pregnancy". The student didn't realize that her health care options were going to be curbed by the university's religious affiliation. The cherry on top? She paid $4,500 for her school's health insurance coverage.
Case 3. Promise. It'll get fun. You are 18 weeks pregnant and you are experiencing abdominal pain. You rush to the nearest hospital, which happens to be PeaceHealth. You have abdominal cramps and vaginal bleeding by the time you arrive to the ER. As the doctors cannot pinpoint the source of infection, the hospital sends you home. You return two days later with an elevated white blood cell count indicating severe infection. You are septic. You have a uterine infection and the only option is to have an abortion to receive treatment. Oh, yeah. PeaceHealth happens to be Catholic. The doctor asks for an ethics committee to review your case and approve the D&C abortion procedure. Within the hour, the ethics committee reviews your case and denies your abortion procedure (O'Neill, 2022). What are you to do?
As hospital systems merge and an increasing amount of providers are employed under these hospital systems, health care regulation is narrowing to the control of a few health system’s policies (Kaye et al., 2016). This becomes particularly dangerous when you consider these hospital systems are operating under religious directives. In 2019, two of the top four largest hospital systems were Catholic (Dyrda, 2019). Providers are slowly losing the ability to provide complete sexual, reproductive, and end-of-life care. Hospital policy has been documented to deny treatment to patients in need, like providing care to a woman experiencing a miscarriage (Kaye et al., 2016).
Catholic hospitals pose an immediate threat. One in every six acute care hospital beds is Catholic-owned (Solomon et al., 2020). As the number of Catholic affiliated hospitals increased by 7.9% between 2001 and 2011, non-Catholic religious hospitals decreased by 38.3% (Uttley & Khaikin, 2016). In a survey exploring patient views of religious institutional health care, 71.4% of respondents believed that their personal choices should take precedence over the religious institution's directives (Guiahi et al., 2019). In another study, 37% of women whose primary hospital was Catholic did not know the hospital was Catholic. Of this group, 66% of women thought the hospital was secular (Wascher et al., 2018).
Not all Catholic hospitals deny all the procedures marked above, but it is important to understand that Catholic hospitals can deny each of these procedures based on the freedom to religion. This poses many ethical dilemmas. Should health care be an avenue for religious expression for either whole systems or individual providers? If yes, will there be a place for patients to express their own beliefs and needs? A lot of time, we believe that patient autonomy should be preserved at all costs, but that doesn't happen to be the case at religious facilities, where freedom to religion prevails.
Furthermore, how does religious care further marginalize minority populations, like females, transgender individuals, terminally ill people, mentally sick people, and people living in rural areas? If a religious hospital is the only hospital that serves a geographic area, should that hospital be allowed to curb the procedures it offers? Should each religious hospital have a transparent page available about what services they do and do not provide? And, finally, as hospitals consolidate into systems and more providers work for systems, what level of authority will providers have to protect their own decisions, as well as their patients' needs?
Stay tuned.
Dyrda, L. (2019, July). 100 of the largest hospitals and health systems in America. Becker’s Hospital Review. https://www.beckershospitalreview.com/largest-hospitals-and-health-systems-in- america-2019.html
Guiahi M., Helbin PE., Teal SB., Stulberg D., Sheeder J. (2019, December 27). Patient Views on Religious Institutional Health Care. JAMA Network Open. doi:10.1001/jamanetworkopen.2019.17008
Helbin, PE. (2020). Pre-health student comfort with health care procedures in the United States: A survey of undergraduate students at the University of Colorado at Boulder. CU Scholar. https://scholar.colorado.edu/concern/undergraduate_honors_theses/fx719n32x
Kaye, J., Amiri, B., Melling, L., & Dalven, J. (2016, January). Health Care Denied. American Civil Liberties Union. https://www.aclu.org/report/report-health-care-denied?redirect=report/health- care-denied
O'Neil, E. (2022, August 05). A pregnant woman was 'writhing in pain,' but a Catholic hospital refused to intervene. KUOW. https://www.kuow.org/stories/a-pregnant-mom-was-writhing-in-pain-but-a-catholic-hospital-refused-to-intervene
Solomon, T., Uttley, L., HasBrouck, P., Jung, Y. (2020). Bigger and Bigger: The Growth of Catholic Health Systems. Community Catalyst. https://www.communitycatalyst.org/resources/publications/document/2020-Cath-Hosp-Report-2020-31.pdf
Uttley, L., & Khaikin, C. (2016). Growth of Catholic Hospitals and Health Systems. MergerWatch, New York, NY.
Wascher JM., Hebert LE., Freedman LR., Stulberg DB. (2018, December). Do women know whether their hospital is Catholic? Results from a national survey. Contraception.
Wenger, O. (2011). Religious beliefs not a barrier to immunizations in Amish community. Healio, 128:79-85. https://www.healio.com/pediatrics/practice-management/news/print/infectious- diseases-in-children/{2b6122ee-c4a0-4856-b97b-ed883d50a911}/religious-beliefs-not-a-barrier- to-immunizations-in-amish-community
Najera, R. F. (2018, November). Very Few Religions Expressly Prohibit Vaccination, Yet Confusion Remains | History of Vaccines. https://www.historyofvaccines.org/content/blog/religion- vaccination-confusion
Grabenstein, J. D. (2013). What the World’s religions teach, applied to vaccines and immune globulins. Vaccine, 31(16), 2011–2023. https://doi.org/10.1016/j.vaccine.2013.02.026
United States Conference of Catholic Bishops. (2018). Ethical and Religious Directives for Catholic Health Care Services. United States Conference of Catholic Bishops, Washington, DC. http://www.usccb.org/about/doctrine/ethical-and-religious-directives/upload/ethical-religious- directives-catholic-health-service-sixth-edition-2016-06.pdf
The National Catholic Bioethics Center. (n.d.). National Catholic Bioethics Center: Gender Identity Disorder and “Sex Change” Operations. Retrieved March 1, 2020, from 38 https://www.ncbcenter.org/resources/frequently-asked-questions/gender-identity-disorder-and-sex-change-operations/
Hiltzik, M. (2016, January). Column: Here’s another case of a Catholic hospital interfering with patient care. Los Angeles Times. https://www.latimes.com/business/hiltzik/la-fi-mh-catholic- hospital-interfering-with-medical-care-20160108-column.html
Hempen, F. (2019). What the new Vatican document says about hysterectomy. Couple to Couple League. https://ccli.org/2019/01/what-the-new-vatican-document-says-about-hysterectomy/
Masci, D. (2016, June 21). Where major religious groups stand on abortion. Pew Research Center, Washington, DC. https://www.pewresearch.org/fact-tank/2016/06/21/where-major-religious- groups-stand-on-abortion/
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