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Across the country we hear about various crises in health care. Poor people are without insurance. HMO bureaucrats seek to impose limits on what services physicians can prescribe and patients can receive. Hospitals are understaffed and overburdened

But there is one slowly growing crisis which we don't hear much about - not nearly enough. All over the country nonsectarian hospitals with financial difficulties are merging with hospitals sponsored by Roman Catholic, Baptist, Adventist, and other religious denominations. Part of the price of these mergers and hence financial solvency is that the nonsectarian hospitals are obligated to adopt and enforce the moral codes of the denominations involved. Decisions about patient treatment are thus made based upon religious edict, not medical fact.

Although the mergers occur with more than just Catholic hospitals, the fact of the matter is that hospitals operated by denominations like the Methodists, Baptists and even Jews are not nearly so pervasive as those operated by the Roman Catholic Church. In addition, most of the hospitals operated by other religious groups are administered in a largely secular manner - meaning that they don't generally try to impose their religious ideals upon the local community. Thus, Catholic polices are the focus here.

The basic situation is that the nearly 600 Catholic hospitals in America are governed by rules prescribed by the doctrines of the Roman Catholic Church. These doctrines are in turn created by religious leaders in the Vatican, far from the immediate needs and situations of the people affected. The Ethical and Religious Directives for Catholic Health Care Services is a set of 70 guidelines which were issued by the National Conference of Catholic Bishops in 1994. These directives stipulate at the beginning:

#5  Catholic health care services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives for administration, medical and nursing staff, and other personnel.

Now, there is little cause to complain about this. If a hospital - or indeed any organization - is somehow funded or supported by the Roman Catholic Church, the Catholic leaders are justified in having a say in how such organizations are run. If a hospital is under the direct control of the Roman Catholic Church, no one should be the least bit surprised if religious leaders set the policies for that hospital.

We may not like those policies and we have every right to criticize them and even find problems or flaws in them. But in the end, non-Catholics have little justification in demanding any changes. Indeed, even Catholics have little recourse in demanding changes, considering the totalitarian nature of the Church. But, it's their Church.

Matters change, however, when a Catholic hospital merges with a non-Catholic hospital. Suddenly, a hospital which was not formerly obligated to follow Catholic theology and church doctrines finds itself in the position of doing just that:

#68  Any partnership (such as with other non-Catholic hospitals, e.g.) that will affect the mission or religious and ethical identity of Catholic health care institutional services must respect church teaching and discipline.

In other words, the Catholic teachings which Catholics and employees of Catholic organizations normally have to obey now also apply to non-Catholics who weren't given a choice in the matter.

Once again, a Catholic hospital considering a merger with a non-Catholic hospital has every right to put conditions on that merger. Normal conditions in any merger might include things like financing and who will be in charge. In the case of a Catholic hospital, they are perfectly justified in adding a condition that the other hospital also follow Catholic doctrine.

However, people in the community have much greater justification in criticizing and complaining about these developments because they involve non-Catholic institutions serving non-Catholic citizens being forced to follow Catholic theology. This effectively means that health care choices of all people are suddenly limited by Catholic theology. What gives the Vatican the right to determine the boundaries of health care for an entire community in America?

Although it is true that, under some circumstances, people can choose to go to some other hospital, this is not true in all circumstances. Indeed, it is not unusual for there to be only two hospitals in a small area - one Catholic and one non-Catholic. The advent of a merger is simultaneously the advent of new and unwanted limitations on everyone. This is especially true of the poor who lack the resources to travel a couple of hours to the nearest non-Catholic hospital.

Just how far have things gone? Let's look at the numbers...

The Numbers

There are currently 5,057 local community hospitals in the United States, out of which more than 3,700 are part of networks or systems of some sort. Most of these do not involve Catholic institutions, but there were more than 120 mergers of affiliations between Catholic and non-Catholic facilities during the 1990s. Catholic systems now control 509 hospitals, up 11% from 1997.

Just consider: there are now 91 regions in the United States where a Catholic hospital is recognized by the federal government as the "sole provider" of health care and hospital services in the community because nothing else is close enough. This is up from only 76 such regions in 1997, and 75% of these hospitals are in areas where Catholics make up less than 25% of the population.

What this means is that there are 91 areas in the United States where people, mostly non-Catholics, cannot receive a host of legal medical services because of the decisions made by religious leaders in the Vatican in Rome. Do you live in one of these regions? The fact that you probably don't even know speaks volumes - and unfortunately, Catholic leaders may not even want you to know.

The Consequences

What is affected? The obvious services are usually reproductive in nature: abortion, contraception, sterilization and infertility treatments. Even HIV prevention counseling can be banned. But a lot more which people might not expect are also affected: end-of-life services such as living wills, advance directives, and desires that some treatments be discontinued.

Who is affected? Anyone who works for these institutions or who comes in as a patient, regardless of religion. As Rev. Tom Davis, a United Church of Christ minister observed, this means that people of all faiths - or no faith at all - have the "ethical and religious directives of one church" imposed upon them.

Doctors, nurses, administrators and all other staff are also affected, because they are forced to abide by the religious codes. This means that they not only cannot provide certain services, but they cannot even discuss those services and recommend other facilities. This results in an erosion of legal health services in local communities - often among the poor who can least afford such a limitation on their choices.

Does it matter? Besides the fact that communities are losing important and legal health care options, serious questions about the separation of church and state are raised. These Catholic hospitals might be privately controlled by the Catholic Church, but they also received funding and support from the government. It seems unconscionable that the government would financially support restrictions on people's legal choices.


How does this happen? It all occurs in private negotiations without consultation with the patients, the doctors, or local community leaders. Very often, people don't find out until much later what has happened. When six nonsectarian hospitals joined with two Catholic hospitals in the Tampa Bay area of Florida, they created a consortium called BayCare. Not until one year later were the secret religious conditions of the deal revealed to the community.

In New York, there was a proposed bill that would have done nothing more than require the State Department of Health to notify local communities about proposed mergers between Catholic and non-Catholic hospitals and seek comments from the people. This would have, in effect, allowed people to know about potential future restrictions on their health care choices.

Unfortunately, Roman Catholic Bishops vociferously attacked the bill, declaring that it "would force those in the Catholic health care ministry to violate their deeply-held moral beliefs... or abandon the health-care ministry entirely." Apparently, one of those deeply-held moral beliefs is that the people they are supposed to serve don't deserve to be told when their legal choices are eliminated by religious decree.

This desire for secrecy says a lot about the goals of Catholic leaders. If they cannot get the people to vote their way and ban certain choices by law, then perhaps they can slowly eliminate them by buying or merging with health care institutions and imposing their views on everyone before they know what is happening.

Keep reading: Reproductive Health Services.

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