Catholic health care services are buying up an increasing number of hospitals in the United States — 1 in 6 hospitals now answer to the Catholic authorities — and in many towns, the only hospital in the area is Catholic. This normally wouldn't be a problem, except that these hospitals usually have to follow the Ethical and Religious Directives for Catholic Health Care Services, which expressly forbid any care seen as fiddling with the "natural" course of reproduction. Interpreted faithfully, means no abortion, no contraception, no sterilization, and a ban on many fertility treatments.
Some hospitals even frown on referring patients out so they can get these services elsewhere.
Researchers from the University of Chicago and the University of California, San Francisco have a paper coming out in the September issue of Perspectives on Sexual and Reproductive Health that looks at the impact of these policies on the ability of physicians to act according to their conscience and medical judgement.
The answer was not good. In interviews with 27 physicians with a variety of personal religious beliefs, the researchers found that these directives frequently infringed on a doctor's conscience, forcing them to offer less than the best standard of medical care. While it was uncommon for doctors to flatly denied the right to refer patients out — often sending them to Planned Parenthood — having to do so still caused unnecessary stress and medical risk for the patients.
"For example, if a patient wants a post-partum tubal ligation but delivers her baby at a Catholic hospital that prohibits sterilization, the doctor commonly refers the patient to a different hospital to get a tubal ligation at a later time," researcher Debra Stulberg explained over email. "But depending on the patient’s specific situation, this can increase the risk of harm to patients or leave the patient with serious barriers to getting care."
For instance, she went on to explain, if a C-section patient feels done with her child-bearing, it's often in her best interest to perform a tubal litigation right then and there, to minimize the number of times the doctors have to cut into her. But forcing the doctor to refer her out for the sterilization means "the unnecessary risk of a second surgery and second round of anesthesia" at another hospital.
In other cases, Stulberg went on to explain, doctors had patients come in "in need of immediate treatment which the Catholic hospital would not allow," forcing the doctor to send the patient to another hospital.
"In some instances doctors felt this transfer or referral was not in the patient’s best interest, because it meant a delay in treatment and the patient having to go to an unfamiliar care setting," Stulberg explained.
It's tragic enough, for instance, having a miscarriage. But being shuffled around from hospital to hospital because your usual one considers it "abortion" to clean out the uterus after a failed pregnancy makes it much worse.
Because of this, many doctors consider not accepting new patients "who might have similar complications" in the future. But, to make the situation even worse, the hospitals often pressure them into taking these patients anyway, because services like childbirth and fertility treatments are lucrative. So doctors who want to do a good job are being pressured by employers to take on patients, and then they are forbidden from offering them the proper course of treatment.
Reading the study, what is striking is how these Catholic directives force doctors to violate their own consciences. Making women jump through hoops or even go through extra surgeries to get basic care is, to a responsible physician, unconscionable behavior. But their Catholic bosses leave them no choice but to do things they know are wrong, all in the name of "ethics".
It's ironic, because the anti-choice movement has seized on the idea of "conscience" as a weapon to use in their war on reproductive health care.
Last month, the House passed the Conscience Protection Act, which supposedly prevents discrimination "against a health care provider based on the provider's refusal to be involved in" abortion.
On the surface, it sounds all fine and dandy — no one wants to force doctors to perform elective abortions if they don't want to — but if you dig into the bill's language, it immediately becomes apparent that this is about giving a bunch of random people, most of whom are not doctors, the right to stop your abortion on the grounds that what you do with your body somehow violates their conscience.
The trick is in how the bill defines "health care provider." Most of us hear that term and think "doctor" or maybe "nurse." But according to Republicans, a whole range of people are owed ownership over a woman's health care decisions.
"Health care providers include health care professionals, health care facilities, social services providers, health care professional training programs, and health insurers," the bill reads.
The term "health insurers" is vague, but the White House argues that the intention is to define it so broadly as to include a woman's boss, on the grounds that because they offer health insurance as part of the benefits package, that makes your boss your "health care provider."
Indeed, the political background of this bill demonstrates that the point of it is to redefine a woman's boss as her "health care provider."
The bill was a reaction to California passing a law requiring health insurance plans to cover abortion, which would restore the abortion decision-making power to those who are directly affected, i.e. the patient and the doctor, and not have other people, such as your boss, meddling with it. So the right created a workaround, trying to redefine a whole range of people as "providers" so any one of them can deny a woman abortion coverage.
The conservative definition of the word "conscience" is, it turns out, quite slippery indeed. In Republican-land, the person whose "conscience" is most relevant to the abortion or contraception decision is never the person who is closest to the decision, the patient herself. And it's almost never the person second closest to it, the doctor.
No, the right of "conscience" is always given, by conservatives, to faraway, often abstract authorities: The church, far-away bishops, the CEO of your company. They don't know you, but, according to Republicans, they know better than you or your doctor what's best for you and your family.