As the Trump administration continues to attack women’s reproductive rights, an important, but little understood trend is already reshaping health care options for women. Catholic-run or -affiliated health care institutions are taking up a growing share of the U.S. health care sector.
Why should this matter? Although Catholic facilities are in some ways comparable to their secular counterparts, there is one major exception. They are governed by a set of 72 Directives set by popes, bishops and Vatican councils that restrict women’s reproductive care and other services. And this week, the US Conference of Catholic Bishops (USCCB) annual Spring General Assembly seems primed to discuss how to tighten implementation of these Directives.
A lot of women across America may find their care limited by these Directives, as increasingly Catholic health care becomes the only game in town. Drawn by Catholic hospitals’ special tax breaks, secular hospitals are merging with their Catholic peers to shore up revenue. Between 2001 and 2016, the number of Catholic-owned or -affiliated hospitals increased by 22 percent. Today, Catholic hospitals treat one out of every six hospital patients in the United States. In some rural areas, Catholic hospitals are the only available facility within at least 35 miles for Catholics and non-Catholics alike.
The Directives that guide these facilities forbid doctors from providing modern forms of contraception (including tubal ligations and vasectomies), in vitro fertilization, and abortion — even in cases of rape or incest. They restrict treatment for ectopic pregnancies. Patients cannot benefit from embryonic stem cell research. Sexual assault victims cannot access emergency contraception until it can be proven that they are not pregnant. Patients’ advance medical directives for end of life decisions can also be overruled.
The Directives deny patients the right to follow their own conscience in making health decisions. They can also run contrary to providers’ professional ethics to always put their patients’ care first.
Take for example the case of Jessica Mann, a 33-year-old pregnant woman in Michigan who was diagnosed with a brain tumor. Her nearby Catholic hospital, Geneysis Regional Health, refused to perform a post-Cesarean sterilization her doctors ordered to spare her health the strain of future pregnancies. In St. Joseph’s Hospital and Medical Center in Arizona, a patient was provided an abortion after the right side of her heart started to fail from cardiogenic shock, which is often fatal if not treated immediately. Sister Margaret McBride, who approved the lifesaving decision, was excommunicated by the local bishop for “formally cooperating” in an abortion. Some doctors provide referrals to patients secretly when they worry that Directives can have a negative impact on a patient’s health.
The Directives can flow down to secular hospitals when they merge with Catholic ones. Bishops approve these mergers and can decide how strictly the Directives should be applied across all institutions in a merger; and from the looks of this week’s meeting the bishops may be keen to enforce these Directives more strictly. Yet, patients are often not properly informed about how a merger might impact the range of services available to them.
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