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Ethics in the news: Catholic hospitals
Recently Catholic hospitals have received a large amount of media coverage in the news and on the Internet stemming from certain decisions concerning healthcare and ethics. One case in particular occurred earlier this year when the amniotic sac of a pregnant woman in Manchester, NH, tore, and she was in the midst of experiencing a miscarriage.
Reportedly, she was rushed to her local hospital, which had recently merged with a Catholic hospital. Because the doctor still could detect a fetal heartbeat, due to directives of the Catholic Church, he was unable to perform a uterine evacuation that would help complete the miscarriage.
Stories like this one are not remote incidents. According to Barry Lynn, executive director of Americans United for Separation of Church and State, based in Washington, DC, issues like this one occur more when hospitals merge. "When a Catholic hospital joins with a non-Catholic hospital, the latter is almost always required to accept the church's directives," Lynn says. (For more information on directives, see box below.)
Vatican to update Catholic hospital guide
Vatican officials believe that controversies over bioethical standards at U.S. Catholic hospitals show the need for greater Catholic education for healthcare workers.
According to reports coming out of the Vatican, church leaders said a new set of biomedical guidelines will be published later this year, as well as a separate document on AIDS prevention.
According to Bishop Jose L. Redrado, the secretary of the Pontifical Council for Health Care Ministry, in the updated guide, the language should be clear and explain what the church says, where the frontiers are, and where there is a risk of crossing the line. Health care ethics guidelines for Catholics were updated before in a 1995 document, The Charter for Health Care Workers, but it has not been updated since. A great many things have changed since 1995, including a significant surge in abortion rates around the world, as well as the rapid development of destructive embryo research and artificial reproduction technologies.
Because of the directives of the Catholic Church, healthcare providers at Catholic-affiliated facilities are not allowed to perform procedures that the Catholic Church deems "intrinsically immoral, such as abortion, and direct sterilization," says Lynn. Also included in that list are birth control, ectopic pregnancies, embryonic stem cell research, in-vitro fertilization, sterilizations, and more.
Susan McCarthy, clinical ethics director, Ministry Health Care, Milwaukee, WI, begs to disagree with those reports. "There is no directive requiring the absence of fetal heart tones prior to medical intervention," McCarthy says. She points out that the operative Ethical and Religious Directive in cases where the fetus has not reached viability is no. 47: "Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child," McCarthy quotes.
In some cases, directives can provide a good model for holistic healthcare, according to J. Vincent Guss Jr., DMin, BCC, medical ethics director, Kaiser Permanente West Los Angeles Medical Center. "For example," says Guss, "directive 46 provides that 'compassionate physical, psychological, moral, and spiritual care [should be] given to those who have suffered from the trauma of an abortion.'"
Guss points out, however, that some directives can be viewed as negative, or provide an effect viewed negatively, such as directive 45: the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus is never permitted. Lynn says, "[The directives] reduce healthcare options for people in the community and force non-Catholics to accept church directives that they may not agree with."
The hospital in this particular case in New Hampshire decided against providing treatment, but as Guss points out, ethics committees are not entities that are equipped or chartered to mandate or forbid clinical treatments. "Rather," Guss says, "they exist to provide a forum and moral climate of discussion and exploration of a range of possible treatments that can be ethically justified." Guss says that the committees attempt to rationally apply bioethical principles to clinical situations and give voice to the expression of values to all of the stakeholders in clinical cases. "They serve patients, families, clinicians, and the community in a consultative and educational role as a resource to decision-makers," he says.
What's next for separation?
Although no one knows the future of the separation of church and state, Guss predicts that the status as it pertains to healthcare will remain the same: very little separation.
"Religious institutions receive public funds," Guss says. Governmental bodies highly regulate them. "To say there is a true separation is spurious," Guss says.
Lynn believes that the face of American religion is changing, so true separation might be possible. "Americans remain a spiritual people, but many are finding a religious home outside of the traditional dogma of established houses of worship and are adopting a 'do-it-yourself' spirituality," he says. "This means people will be less likely to automatically defer to and blindly accept church teachings, especially those that relate to personal decisions, like those connected to healthcare."
McCarthy says, "as the provisions of the Affordable Care Act are implemented, we hope to see more affordable and more accessible care for all, regardless of the sponsorship Catholic or otherwise of the healthcare facilities chosen by patients. I don't anticipate any conflicts to arise regarding the separation of church and state."
With each incident such as the New Hampshire woman, lessons can be learned.
Guss says, "Ethics consultants have the responsibility to help decision-makers, i.e. clinicians and the patient/family/surrogate, to weigh the risks and benefits of any healthcare decision. If the life and/or long-term health of a patient is threatened by a decision not to give the medical treatment required in an emergency because of the care provider's moral conscience, that care provider should seek to help the patient find another provider who is willing to provide the necessary treatment in a timely and safe way."
McCarthy mimics the sentiment by Guss, "We are proud of our Catholic heritage and of the care we provide, regardless of ability to pay."