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Bishops revise Catholic health care directives.

New partnerships cause ethics conflicts in Catholic health care facilities

Catholic health care in the United States predates the formation of the Union, but only in recent years has this vast network of Catholic hospitals run into the problems commonly associated with free-market health care.

Increasingly, once-independent Catholic hospitals, seeking relief from financial pressures, are affiliating with nonsectarian institutions -- affiliations that often require compromises related to the church's teaching on sexual ethics. New health care partners often don't agree with the church's bans on sterilization and abortion, and the pressures of the market can be difficult to reconcile with church teaching.

Some of the recent arrangements have commanded the attention of the Vatican's Congregation for the Doctrine of the Faith, which essentially takes a no-compromise stance when it comes to Catholic teachings on sexual ethics.

Now, with an eye to closing loopholes that might have given ethicists and bishops wiggle room in striking deals, U.S. bishops, under Vatican scrutiny, have been revising the language in their Ethical and Religious Directives for Catholic Health Care Services.

The U.S. bishops have received a fourth draft of the proposed revision -- already approved by the Vatican -- and they are expected to vote on new language for the directives when they meet in Atlanta June 14-16.

Among "creative solutions" that were devised previously, causing the recent revision of the directives by the bishops, sterilization referrals were sometimes made to a unit of the hospital that was under separate control from the main "Catholic" hospital. In such cases -- and in others, where sterilizations might even be done within a Catholic institution -- ethicists and bishops have drawn their arguments from the principle of cooperation in instances of duress.

Notre Dame law professor Cathleen Kavney says the directives will help provide guidance when Catholic and non-Catholic institutions affiliate. A key point being articulated in the directives is "how close you can get to a wrongful act performed by somebody else," Kavney said. The directives are clear, says Kavney -- Catholics cannot justify immediate material cooperation with sterilization, abortion or euthanasia. However, Kavney says two hospitals can affiliate and still maintain some of their distinctness.

"Corporate law is flexible enough to allow that," Kavney said. "So you can have a system that includes a Catholic hospital that's still a Catholic hospital and a non-Catholic hospital within the same system, not necessarily within the same building." Where patients are concerned, the argument goes, to ban sterilizations completely could threaten the health of some patients, particularly where access to health care is limited. Where institutions are concerned, an overly rigid approach to mergers could threaten survival of Catholic health care in a community.

Fr. Michael Place, president of the Catholic Health Association, said the revised directives more specifically define limits for Catholics working in newly merged facilities.

"We needed some direction with regard to how we proceeded when we've entered into arrangements with folks who do not share all of our values," Place said.

"At the heart of the matter right now is the question of sterilization," said Bishop Donald Wuerl, one of the contributors to the revised directives. "How involved can a Catholic health care institution be in any institution or structure that provides sterilization?" he asked in an interview.

"Abortion and euthanasia are already clearly ruled out because the directives were much more precise in dealing with those. The directives say under no circumstances can abortion be tolerated in Catholic hospitals -- even using the principle of material cooperation. And now the question is to make the same clear, categorical prohibition against sterilization, against direct sterilization.

"The Holy See is reminding all of us that direct sterilization is immoral, and a Catholic cannot be involved in that procedure," Wuerl, bishop of Pittsburgh, said.

Regardless of how narrowly Catholic, health care directives are written, interpretation of the rules will remain in the hands of the local bishop, Wuerl said.

For many in Catholic health care, though, including many moral theologians, it is unfortunate to write rules for health care that suggest sterilization and abortion are evils of the same magnitude.

Said Kavney: "I don't think that there is any effort to say that sterilization and abortion and euthanasia are wrongs of the same seriousness. I think that's clearly not meant to be said. But what they are saying is that the principle of material cooperation with evil can't be used to justify Catholic hospitals performing any of these acts. ... They're making things a bit more stringent with respect to sterilization."

Also keeping an eye on developments is MergerWatch, an Albany, N.Y.-based group that claims to monitor "threats to reproductive health care and patients' rights."

"It's been our hope that the use of these creative solutions to continue reproductive services at non-Catholic hospitals could be actually expanded, not restricted," said Louis Uttley, MergerWatch director. "We are very concerned about any action the bishops might take which would make it more difficult to preserve access to services at non-Catholic hospitals when they form business partnerships with Catholic facilities."

Groups such as MergerWatch say they're particularly concerned about hospitals in rural areas that come under Catholic control. These places may be the only facilities for miles offering birth control options and/or abortions.

On the other hand, Msgr. Dennis Regan, vice president for mission and ethics at Catholic Health Services of Long Island, said Catholic institutions must be wary of what some term "creative solutions" that could jeopardize Catholic identity.

Catholic Health Services of Long Island oversees Catholic health care facilities in the Rockville Center, N.Y, diocese, all of which are operated by the diocese.

Partnerships with non-Catholic entities are necessary and often very complex, Regan said, but "creative solutions" can result in Catholics "in reality or in appearance lacking integrity or talking out of both sides of our mouths."

Said Uttley: "We certainly understand the financial reason why hospitals are looking to affiliate and merge, including Catholic hospitals, but we don't feel that these mergers should be allowed to impose one religion's beliefs about health care on nonsectarian hospitals which serve the whole community."

The strongest critics of Catholic health care directives are affiliated with a loose coalition of groups that back abortion rights, said Place of the Catholic Health Association. "Their focus is not just the mergers," he said. "Their goal, stated several times, is every Catholic hospital, merged, unmerged, should be to required to provide abortions and sterilizations. That's where they're going with this.

"I don't know of anyone raising these objections to particular mergers who is not associated with the pro-abortion agenda," he said.

Professional groups have also become involved.

Last November, the American Public Health Association recommended more government oversight of mergers to protect reproductive health services. Conversely, last June, the American Medical Association passed a resolution reiterating support for hospitals that restrict certain services for moral reasons.

Sometimes lost in the debates over the directives is the enormous contributions Catholic health care provides nationally, Place said. "Catholic health care is the largest single aggregate within the not-for-profit sphere of health care delivery in the United States," Place said. "And we are there because of our commitment to the well-being of individuals, most particularly to those who are vulnerable and in need.

"We believe that it's a pluralistic society, that we have had a historic covenant in this country that has given the space within the voluntary sector for faith-based organizations to do social good in a manner that's consistent with their own values."

Regan of Catholic Health Services of Long Island said good intentions and a desire to preserve Catholic health care are the primary motivating factors behind seeking creative solutions. "I am not judgmental about their efforts to try and work out [compromises that] respect some of the other people's values," he said. "In some cases it worked. Other cases it went a little too far.

"That's not surprising. This entire industry is in an incredible state of flux, and changing, sometimes not even daily, but from morning to afternoon," he said.

The challenge, said Wuerl, is to maintain theological integrity in the face of that dynamic.

"That's the challenge of being Catholic," he said. "It's true of Catholic health care. It's true of Catholic education. It's true of Catholic charities. It's true of Catholic social service ministry. What we bring to the market is our faith, our gospel values, our conviction that we're doing this out of the love of Jesus Christ..... We will be different because of that, and we're going to run into difficulties because of that, but that's who we are and that's why Catholic identity drives Catholic health care."
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Publication:National Catholic Reporter
Geographic Code:1USA
Date:Jun 1, 2001
Previous Article:WORLD.

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