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Does the Vatican Have a Say in Your Health Decisions?

As more health facilities merge with Catholic hospitals in response to economic hardship, patients' rights are increasingly restricted by Catholic doctrine.

In the first months of her pregnancy, Candace Rich informed her doctors that she wanted to have her tubes tied. Tubal ligation is cheaper and easier on the patient's health when done during a Cesarean section, so Rich asked her doctors to perform the procedure if she required one. Two days after her due date, Rich was told that she would need a Cesarean but that the hospital refused to perform the simple operation because St. Luke, formerly a secular facility, now operated under Catholic doctrine.

"The doctor told me that 'because of the Vatican,' St. Luke could no longer do that procedure," said Rich in an affidavit. She was forced to find another hospital in the last few days before her surgery and to pay for the full cost of the operation.

Across the country, an increasing number of secular medical facilities are merging with Catholic hospitals to stave off the effects of a difficult economy; a union that proves less than holy for those, like Rich, who seek medical procedures no longer performed by the joined facilities. And many hospitals under Catholic management operate according to doctrine that restricts or prohibits performance of "non-Catholic" procedures, including tubal ligation, a surgical method of sterilization that devout Catholics consider an infringement on God's plan for reproduction.

There are currently about 600 Catholic hospitals in the United States. They manage nearly 20 percent of all hospital beds or one in five of all medical visits logged every year. Forty-eight of these hospitals are considered “sole providers” for a region, rendering many communities without vital medical care options. These organizations are under the direct supervision of the United States Conference of Catholic Bishops (USCCB). Local bishops and both the institutions and their employees are held to strict standards of care dictated by Ethical and Religious Directives (ERDs), which are approved by the Vatican.

The Ethical and Religious Directives are 72 points that outline Catholic medical doctrine. Some of the more contested directives specifically prohibit patient access to, information on, or referrals for procedures or counseling. For instance, Directive 52 denies the use of all contraception except “natural family planning.” Even when addressing patients on HIV or STD prevention, abstinence is advised. Voluntary sterilization (Directive 53) is prohibited for men and women, even when the procedure is easiest after a Cesarean section birth.

In the case of emergency contraception (also known as Plan B or the "morning after" pill), variations in state law have rendered Catholic issuance of emergency contraception inconsistent. A November study from the Guttmacher Institute reports that 17 states and the District of Columbia require hospitals to provide emergency contraception, and 16 states and the District of Columbia require hospitals to provide information about emergency contraception. Stories of non-compliance with these laws abound. A 2003 survey conducted by Catholics for Choice found that 23 percent of Catholic hospitals offered emergency contraception only to victims of rape; only 5 percent offered it without question.

Directive 45 of the Ethical and Religious Directives states that abortion "is never permitted" although it allows for exceptions including surgical procedures for ectopic pregnancies. (A medical abortion is prohibited because the purpose of the drug is to bring about an abortion; surgery, a much more invasive and expensive procedure, is allowed because the objective is to save the woman’s life.)

Various directives address fertility treatments. Fertility procedures are permitted only when a married couple uses their own egg and sperm; third-party donors are prohibited. Drugs that induce egg and sperm production are permitted. Lesbians and unmarried women are not allowed fertility treatments of any sort. And Directive 50 prohibits prenatal diagnosis "when undertaken with the intention of aborting an unborn child with a serious defect."

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