These
days it seems like all I hear about are the twin crises of budget and
healthcare, so I wasn’t surprised when one of my very first assignments
this summer at LSRJ was to research religious hospitals and their
funding. What did surprise me, however, was what I learned about the
disparate standards of care between secular and religious healthcare
facilities.

One out of every six patients in the U.S. is cared for in a Catholic hospital. In fact, the Catholic healthcare system is the largest private non-profit provider of healthcare in the nation – 70% of religiously affiliated hospitals identify as Catholic.  Because
the Catholic healthcare system has significant medical responsibility
for millions of Americans, the services they choose to provide or
withhold can have a profound impact on the overall quality of care in
the U.S. Additionally, religiously affiliated hospitals receive 50% of their funding from Medicare and Medicaid
and also enjoy certain benefits like tax exempt status, low-cost
financing through government bond programs, and in some areas, use of
municipal buildings.

Because
Catholic hospitals receive so much public funding and see so many
patients, one might assume that the standard of care in a Catholic
hospital is comparable to the standard of care in a secular hospital.
Unfortunately, this assumption may not be true.

Some
patients treated in Catholic hospitals – women in particular – may not
be receiving reproductive healthcare considered basic and essential by
secular medical facilities. That is because Catholic healthcare
providers are governed by the Ethical and Religious Directives for Catholic Health Care Services, with which all Catholic health care providers are obligated to comply (Directive 5).

Under
the Directives, Catholic hospitals are prohibited from providing
contraception (Directive 52), sterilization (Directive 53), most
infertility treatments (Directives 40, 41, 42), condom distribution for
AIDS prevention (Directive 52 prohibits all contraception, regardless
of the reason), or abortion services (Directive 45).  Directive 48 goes so far as to say no medical care that could be construed as abortion can be provided, even to a woman with an extra-uterine (ectopic) pregnancy.

It is also difficult to obtain emergency contraception in Catholic hospitals—even as treatment for rape or sexual assault.
Despite the fact that it is expressly addressed in the Directives, the
language of Directive 36 is unclear on when and under what
circumstances EC can be provided:

 

Compassionate
and understanding care should be given to a person who is the victim of
sexual assault. Health care providers should cooperate with law
enforcement officials and offer the person psychological and spiritual
support as well as accurate medical information. A female who has been
raped should be able to defend herself against a potential conception
from the sexual assault. If, after appropriate testing, there is no
evidence that conception has occurred already, she may be treated with
medications that would prevent ovulation, sperm capacitation, or
fertilization. It is not permissible, however, to initiate or to
recommend treatments that have as their purpose or direct effect the
removal, destruction, or interference with the implantation of a
fertilized ovum.

 

Since
emergency contraception is most effective in the first 72 hours, a
healthcare provider’s refusal to provide comprehensive treatment can
further traumatize survivors of rape and sexual assault by forcing them
to leave the hospital and attempt to obtain EC elsewhere.

 

Catholic hospitals do provide a tremendous amount of care in rural and impoverished communities – indeed, they are often the only
hospital in such communities. The question remains, however, whether
funding institutions that refuse to provide the full spectrum of
reproductive healthcare is really the best use of our scarce federal
Medicaid and Medicare dollars.