Storm clouds gathering: while the number of mergers wanes, the threats from the catholic hierarchy to reproductive health care continue.

DESPITE THE FACT THAT THE number of mergers between Catholic and non-Catholic hospitals has been declining, the influence of the Catholic church in seeking to limit women's access to reproductive health care has continued. The Catholic Health Association (CHA), a trade organization representing the nation's Catholic health care institutions, and individual bishops' conferences have spent millions lobbying on a number of fronts: against emergency contraception being made available over the counter, appealing the California Supreme Court decision to require Catholic Charities to provide contraceptive insurance coverage to its employees, advocating for the federal refusal clause in the FY05 Labor, HHS Appropriations Bill and opposing embryonic stem cell research.

THE SCOPE OF CATHOLIC HEALTH CARE Catholic hospitals constitute the largest single group of nonprofit hospitals in the US--over 11% of the nation's total community hospitals and 16.2% of the nation's total community hospital beds. (1) The Catholic health care industry operates in all 50 states and is comprised of more than 600 hospitals and 60 health systems.

The Catholic health care system bears a significant medical responsibility to millions of Americans. In 2001, 31% of Americans received care in a Catholic facility. Unfortunately, Catholic health care systems do not provide women with basic and essential reproductive health services. Catholic health care is regulated by the Ethical and Religious Directives for Catholic Health Care Services (the Directives). The Directives forbid services that contradict church teachings and provide guidelines for Catholic hospitals when forming partnerships with non-Catholic hospitals. The Directives prohibit reproductive health services such as contraceptive sterilization, in vitro fertilization, abortion, condoms and prescribing or dispensing contraceptive devices. (2) Although the Directives do not forbid the provision of emergency contraception (EC) to women who have been raped, they do severely restrict the ease of obtaining EC, a high dose of the same hormones found in birth control pills. Taken within 72 hours of unprotected sex, EC can inhibit ovulation; inhibit the migration of the sperm into the fallopian tube, where fertilization usually occurs; or interfere with sperm capacitation, the process by which sperm becomes capable of fertilizing an egg. A 2002 survey by Catholics for a Free Choice found that only 28% of Catholic emergency rooms provide EC to rape victims. (3)

EMERGENCY CONTRACEPTION OVER-THE-COUNTER

The Catholic Health Association and the United States Conference of Catholic Bishops (USCCB) have mobilized extensive financial and political resources to influence reproductive health services. This extends beyond Catholic health care facilities. In May 2004 the Food and Drug Administration failed to approve EC being made available over the counter. This was due in part to actions taken by the USCCB. The legislative branch of the USCCB, the National Committee for a Human Life Amendment, mobilized its members to oppose the move, and the USCCB'S Office of General Counsel submitted comments to the FDA in opposition to EC approval. The main argument from the USCCB was that EC works as an abortifacient.

The USCCB ignored the reality that EC is not an abortifacient and does not put women's health at risk and ignored the support of the health care community for EC being available over the counter. Making EC available over the counter would ensure that all women may access the drug, including those who might be refused EC at Catholic health care facilities.

Although making EC available over the counter was supported by the FDA'S own Advisory Committee, in the end pressure from groups like the USCCB contributed to the decision by the FDA against making it available.

CALIFORNIA CATHOLIC CHARITIES REQUIRED TO PROVIDE CONTRACEPTIVE INSURANCE COVERAGE

In October, the US Supreme Court refused to hear Catholic Charities of Sacramento's appeal against the state's contraceptive coverage law, which local bishops said amounted to "an unprecedented intrusion upon their religious freedom." In order to reduce discrimination against women, the legislature in California had passed a law requiring employers who provided prescription coverage in their health plans to include contraceptive coverage.

While the law included an exemption from providing contraceptive insurance coverage for religious employers, the California Supreme Court ruled on appeal, and the US Supreme Court agreed by default (as it chose not to hear the case), that Catholic Charities did not qualify as a religious employer because the charity's purpose is secular and it employs people of all faiths. In fact, three-fourths of its employees are not Catholic. Therefore, the court ruled, Catholic Charities must now provide contraceptive insurance coverage to its employees in California.

FEDERAL REFUSAL CLAUSE

The House of Representatives approved the FY05 Labor, Health and Human Services Appropriations Bill in September and the bill has now gone to the Senate. Included in this bill is a federal refusal clause supported by the USCCB, allowing all religious health care providers to be exempt from providing abortions. The clause is unnecessary as Catholic facilities are already protected by the Church Amendment to the Public Health Service Extension Act of 1973 and do not have to provide abortions.

The federal refusal clause goes further than the Church Amendment as it allows any health care provider, not just religious providers, to refuse to participate or provide information on abortion. It would also allow providers to refuse, for any reason, to pay or refer for an abortion. Three prominent Catholic leaders, Msgr. William Fay, General Secretary of the USCCB; Father Michael Place, STD, President and Chief Executive Officer of the CHA, and John Lane, MD, President of the Catholic Medical Association, wrote to the Appropriations Committee asking them to support this amendment.

The federal refusal clause will allow any health care provider to refrain from informing patients of legal and safe health options or from providing referrals. This is a form of discrimination that places an undue burden on women. While it is right for individuals to be allowed to refuse to participate in abortions on grounds of conscience, allowing institutions to require their doctors and nurses to deny information about certain reproductive health services goes beyond health care providers' rights, and infringes on the rights of patients seeking information.

STEM CELL RESEARCH AND PROPOSITION 71

Another health care issue concerning the Catholic church is embryonic stem cell research. Stem cells are cells that have the potential to develop into many different cell types in the body. They can theoretically divide without limit to replenish other cells for as long as the person or animal is still alive. On account of President Bush's 2001 limitations on federal funding for stem cell research, California has proposed the California Stem Cell Research & Cures Initiative, Proposition 71. Proposition 71, which will appear on the November 2004 ballot, would provide funds needed for research into potentially lifesaving therapies and cures for diseases that could save the lives of millions of children and adults and reduce health care costs.

The California Catholic Conference is opposed to stem cell research that uses human embryos. The Conference has established the California Common Good Foundation, a 501(c)(4) organization, in order to join the coalition opposed to the Proposition and to actively involve themselves in efforts against Proposition 71.

Catholics for a Free Choice endorsed Proposition 71 because it will provide much needed funding for stem cell research that could lead to cures for diabetes, Parkinson's disease and spinal cord injuries. A recent poll commissioned by Catholics for a Free Choice demonstrates broad support for stein cell research within the Catholic community. A large majority of Catholic voters (72%) supports "allowing scientists to use stem cells obtained from very early human embryos to find cures for serious diseases such as Alzheimer's, diabetes and Parkinson's." Strong support for this research (34%) outnumbers strong opposition (12%) by nearly three to one. (4)

REDEFINING RELIGIOUS FREEDOM

It is clear that when it comes to the provision of reproductive health services neither Catholics, nor the population at large, support positions taken by the Catholic bishops. A 2000 poll by Catholics for a Free Choice found that women expect to receive comprehensive care regardless of the religious affiliation of the hospital, and 85% believe that if a Catholic hospital receives government funds, it should be required to allow doctors to provide any legal, medically sound service the doctor believes is needed.

While the CHA and the USCCB aim to highlight the importance and commitment of Catholic services to the community, they simultaneously downplay the reproductive health needs of the people they serve. At the core of their strategy is the creation of an ideological framework to redefine the legal concept of religious freedom. While working to deflect claims that granting exemptions to Catholic hospitals from following the law or regulations limits the religious freedom of consumers, the CHA and the USCCB have sought to create the impression that they have a constitutional right to refuse to provide reproductive health services. The problem with this argument is that a social service run by an agency affiliated with the Catholic church is not the same thing as the Catholic church. The Catholic church is provided religious freedom by the US Constitution; its social services are subject to laws and regulations designed to protect consumers. There is clearly a long way to go in this struggle to ensure that women and men visiting Catholic health care institutions get the care they need and want, and the debate will continue in the courts of law as well as those of public opinion.

ENDNOTES

(1) "Catholic Health Care Update: The Facts about Catholic Health Care," Catholics for a Free Choice, July 2002.

(2) "Ethical and Religious Directives for Catholic Health Care Services," Fourth Edition, US Conference of Catholic Bishops, June 15, 2001.

(3) "Second Chance Denied: Emergency Contraception in Catholic Hospital Emergency Rooms," Catholics for a Free Choice, December 2002.

(4) "The View from Mainstream America: The Catholic Voter in Summer 2004," Catholics for a Free Choice, July 2004.

LAUREN STANLEY is the Senior Associate for Health Care Advocacy at CFFC.