Medicine is No Place for Monday Morning Quarterbacks

I know a little about football. I know the basic rules and I have been to a few pro games at Rich Stadium. I also know what I don’t know. As a gynecologist, I would never dream of telling a football coach how to lead a team to the Super Bowl. That’s why I’m mystified and frustrated that CBS is letting someone who knows nothing about my job tell Super Bowl viewers how to handle a complicated pregnancy.

I’m an ob/gyn who provides a range of health care to my patients, including abortion services. I know that some pregnant women face hard choices. Sometimes women end pregnancies to save their lives, or because their health or their baby’s health is compromised.

On January 16, CBS announced that it would broadcast an ad during the Super Bowl in which football player Tim Tebow and his mother, Pam, talk about her pregnancy with Tim. In past interviews, Pam has said that she contracted a dangerous infection during her pregnancy. Because of the medications she was taking, and other health problems, her doctors advised her to have an abortion. Pam refused.

Her story is compelling. Pam Tebow’s difficult pregnancy, however, doesn’t make her an expert in reproductive health, any more than attending a few NFL games makes me an expert on football.

Most women, thankfully, have healthy pregnancies. Others develop complications due to an existing health problem that worsens in pregnancy. Still others learn they have a disease, like cancer, while they are pregnant. When one of my patients faces medical complications in pregnancy, we discuss everything, both the risks and the treatment options.

Pam and Tim Tebow both survived this complicated pregnancy. The women who do not survive are not here to tell their stories, except through the doctors who treated them. I took care of Sarah, a 38-year-old woman with a serious auto-immune disease. Knowing that a pregnancy would threaten her health, Sarah used birth control, but she got pregnant anyway. As her pregnancy progressed, her condition worsened. Eventually, Sarah couldn’t get enough oxygen into her body to survive. We tried all the treatments we had. She was counseled that abortion was needed to save her life but she chose to wait, hospitalized, trying to get to a point when her baby could survive. Her condition deteriorated and finally, with our help, she ended the pregnancy. It was too late. Her heart and lungs was so badly compromised by the pregnancy that she died as her doctors tried to implant a pacemaker. I wish we would have been able to help Sarah sooner; she might be alive today caring for her teenage son.

The Super Bowl is the biggest day of the year for advertisers. As many viewers tune in for the ads as for the game. Front page stories will recount the highlights of the game—and the best and worst commercials that aired. That’s why Focus on the Family, an anti-abortion organization, not a medical organization, raised millions of dollars to air this commercial. They want to tell the broadest possible audience that women with complicated pregnancies can—and should!—ignore their doctors’ advice. As a physician, this leaves me feeling an urgency to get out a different message, one that conveys the reality we see in the hospital every day. Denial does not make risk go away.

When it comes to personal medical decisions, no Monday morning quarterback should be making the calls. For the sake of my patients—and the thousands of other women who face complicated pregnancies each year—I hope CBS will blow the whistle on the Tebows’ ad.

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  • anneb

    But it IS the place of privileged, white men to tell us poor, helpless women what to do…(obviously sarcastic). Great blog, Dr. Davis.

  • crowepps

    They want to tell the broadest possible audience that women with complicated pregnancies can—and should!—ignore their doctors’ advice. … Denial does not make risk go away.

    You are attempting to reason with a group who rejects reason as ‘unChristian’, stigmatizes making decisions as ‘lack of faith’, believes that those who are good and faithful will never have anything bad happen to them (including death before which they’ll be Raptured), and believes that complications of pregnancy are just punishment for ‘bad choices’ the woman made in the past and that therefore she deserves to suffer and die from them.


    This isn’t so much denial of the risk to her as it is the belief that it is dangerous TO THEM if they attempt to thwart their God, a punitive and vicious being willing to slaughter tens of thousands of innocents to punish society for failing to prevent everyone from ‘sinning’.

  • tripledomer

    I thought you guys were pro-choice and not pro-abortion? This is going to be an add glorifying, not the banning of abortion, but the particularly courageous reproductive choice. If you honestly were pro-choice you would be celebrating such an add. You would be saying that this is more evidence that we should trust women to make the right decision and we don’t need to ban abortion. That you are not suggests plays into the meme that what you really are is pro-abortion.

    Croweps, what the hell are you talking about? Polls show that people are getting less religious…while getting more pro-life. The meme that those who are pro-life are religious–or are pro-life because they are religious–is just ignorant. And what it shows is that rather than engage in serious, rational debate you would rather resort to name-calling.

    No wonder pro-choice numbers continue to drop. No wonder 1/4 of the democratic caucus voted for Stupak. Nobody is buying what you guys are selling. Not even your own party.

  • jayn

    Pam Tebow was courageous–she was also lucky.  I have no problem with her decision, and am glad that she and her son both pulled through and are doing well.


    Most problems that come from the pro-life side of things can really come down to them saying there’s only one answer.  Women should get to make their own choices without coercion, but ads like this one add to a social paradigm where that can’t happen–they create such a negative atmosphere around abortion that women have to worry, ‘what will the neighbours think?’ when that should be the last consideration they should be making.  We live in a world that tip-toes around the issue, because people are afraid to talk openly about the other option.  What we need is a world where women who have made BOTH choices can feel free to talk about it.  But we usually only hear about the Pams, not the Sarahs.

  • eternalskeptic

    I was trying to put my finger on why I take issue with this article. It isn’t the patent refutation of the “pro-choice” philosophy of respecting whatever decision a woman makes (Tripledomer has already addressed this eloquently). It isn’t the call for censorship, (although this form of intolerance I do find problematic). I think it was the following statement:

    “As a gynecologist, I would never dream of telling a football coach how to lead a team to the Super Bowl. That’s why I’m mystified and frustrated that CBS is letting someone who knows nothing about my job tell Super Bowl viewers how to handle a complicated pregnancy.”

    Actually, it is NOT your job to tell a woman what to do with her pregnancy and her offspring. Pamela Tebow may “know nothing” about your job. She doesn’t need to. You’re free to provide your medical opinion, but it is ultimately up to the individual woman she handles her complicated pregnancy.

    Second, have you actually seen the commercial? Or are you just speculating on its contents? So far as I know—and I could be wrong because I certainly haven’t seen it–Pam Tebow is sharing *her own* experience, not giving medical advice to other women. But if you have evidence to the contrary, I’m all ears.

    Here was the other part of the piece that caught my attention:

    “They want to tell the broadest possible audience that women with complicated pregnancies can—and should!—ignore their doctors’ advice.”

    Working as I do in the trenches of maternity care reform, (a cause that this site champions, by the way), I grow weary of the “father-knows-best” mentality adopted by far too many physicians. Countless child-bearing women are admonished for going against their doctor’s advice (i.e. disobeying Papa OB) even when that involves refusing anti-evidence practices like routine fetal monitoring and episiotomies. In short, please give Pam Tebow a break and let her think for herself. Women have every right to disregard their doctor’s advice. After all, it’s just that—advice. You’re welcome to your medical opinions, but realize that A) they may vary greatly with those of other physicians and B) this story is about Pam’s choice—not yours or any other doctor’s.

    Thank God Pam Tebow did *not* follow her doctor’s advice. After all, her doctor was wrong, wasn’t he?

  • colleen

     I grow weary of the “father-knows-best” mentality adopted by far too many physicians

    Imagine how normal people feel when confronted with the sanctimonious, authoritarian and babblings of ‘pro-life’ zealots who are willing and eager to urge women to ignore the advice of their physicians






    The only difference between the American anti-abortion movement and the Taliban is about 8,000 miles.

    Dr Warren Hern, MD

  • progo35

    This ad doesn’t tell anyone what to do, it expresses an opinion. Women who hear it are free to do what they want with it: people are not going to start ignoring their doctor’s advice based on a tv commercial.
    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • womantrust

    Pam Tebow made- per the spokesperson for Focus on the Family, who produced and paid the $2.5 million to air it. Some of those who see it (in the 1st quarter), will get the subliminal message that it’s o.k. to risk the life of the woman and pregnancy when that may not whats best at all. But tied in with feelings about this big game (watched by millions), can be those feelings about ‘risking it all’, ‘going for the gold’, scoring a touchdown, etc. so if/ when they’re faced with this kind of decision, their thinking can be clouded with the excitement and glory associated with this event, and mar their judgement in making or supporting the decision that’s best for all. As to the story, abortion is and has been illegal in the Phillipines for over 100 years- even to save a woman’s life. So, the credibility of this story is questionable to say the least. However, it does shore up the anti- choice (make safe abortions illegal), and anti-contraception agenda that Focus on the Family claims; as well as Pam Tebow’s invitations and speakers fees at anti- choice events around the country. This is troubling to anyone who truly supports reproductive choice and understands what is going on here. All it takes is a little looking past the obvious. Those who attempt to ‘call out’ others who are concerned with the message this ad promotes probably don’t know or understand why it can be so dangerous. Yes, we support the right of all women to choose, but we want the truth to be told. We also want respect and concern shown for the women who made this hard choice and terminated their pregnancies. They’re here to tell their experiences just like Pam Tebow, but don’t get the chance. Don’t they deserve as much time and respect as Pam Tebow? It’s also troubling to think that same money could have been used to help women and children already born, who are struggling just to survive- as well as people in Haiti. This ad (per FOF), is an ‘advocacy’ ad- advocating ‘life’- even at the risk of death. CBS has either been ‘had’ or sold out on it’s own policy of not running advocacy ads on Super Bowl time. Abortion has become so stigmatized in this country, do you think if an ad advocating abortion were presented to CBS for tht same $2.5 million for 30 seconds, they’d run it? We all know the answer to that.

  • intentional-birth

    The reproductive freedoms that every woman should have access to include the option to disagree with my doctor and to make personal choices that my doctor disagrees with.

    As a pro-choice woman of childbearing age, I am particularly interested your argument: a woman should not tell her story of how she made an autonomous medical decision against her doctor’s advice and had a positive outcome (and demonstrates her doctor was wrong in this one case).

    You say this ad expresses “that women with complicated pregnancies can—and should!—ignore their doctors’ advice. As a physician, this leaves me feeling an urgency to get out a different message, one that conveys the reality we see in the hospital every day. Denial does not make risk go away.”

    The fact is: reproductive choice includes the RIGHT to ignore my doctor’s advice, even when the doctor believs there is increased RISK to my life and the life of my unborn child (homebirth, VBAC, refusal of cesarean, etc). And your obligation as a physician is to counsel me on the reasons for your recommendation and then respect my autonomy, and not intervene against my wishes, regardless of the consequences.

    Your position in this article is in direct opposition to true reproductive freedom. When I’m making a decision about my health and my life, it’s no one’s business to make it for me or to determine that I shouldn’t be permitted to scream it from the rooftops- even if it does persuade others to make similar choices (and even if it is used for propaganda from a big pro-life group.)

    Your argument implies women aren’t smart enough to make personal decisions when faced with conflicting information (propaganda ad and doctor advice) and this opinion is reflected in the state of poor doctor-patient relationships within the maternity care system today.

    Respect that the women you treat are independent, autonomous people who not only have the right to make decisions you don’t agree with, they have the right to listen to conflicting information too. Trust that women have the ability to sort through facts and ideas and make decisions that are right for them.

  • eternalskeptic

    This is the first time–and hopefully not the last–that I am in 100% agreement with a post from a pro-choicer.  Beautifully stated! 

  • anneb

    Choice is a great thing. This whole thing isn’t about Pam Tebow’s choice. It’s about CBS breaking their policy on ideological ads.

  • crowepps

    Thank God Pam Tebow did *not* follow her doctor’s advice. After all, her doctor was wrong, wasn’t he?

    Considering that you tout yourself as a skeptic, I almost hesitate to point out that nobody has any clue what her doctor’s advice actually was, but instead just an evolving self-report from a woman who makes generous speaking fees by complaining that an ‘evil doctor’ tried to talk her into ‘murdering’ a future football star.


    As a skeptic myself, I am hesitant to believe that advertising statements by self-promoting drama queens are always 100% ‘the truth’.

  • crowepps

    Croweps, what the hell are you talking about? Polls show that people are getting less religious…while getting more pro-life. The meme that those who are pro-life are religious–or are pro-life because they are religious–is just ignorant. And what it shows is that rather than engage in serious, rational debate you would rather resort to name-calling.

    Focus on the Family will be stunned to realize you haven’t grasped that they are a religious organization — an evangelical Christian one that promotes exactly the tenets and mindset I described.

  • jodi-jacobson

    I keep being told it just "celebrates life."


    Whatever that means.

  • crowepps

    people are not going to start ignoring their doctor’s advice based on a tv commercial.

    Many of the things in TV commercials are things doctor’s would just as soon their patients avoid, and as to whether people will ‘ignored their doctor’s advice’ based on those commercials, why do you think advertising for cigarettes is banned on TV?  Why do you think there’s controversy over advertising liquor?

  • crowepps

    As opposed to those who think abortion should be legal — you know, those of us who apparently ‘celebrate death’ because we immorally focus instead on the lives and health of irrelevant women.

  • progo35

    What I’m not totally clear about, but I think I understand is that a)the issue was the medication Pam needed to take. b) the producers of the ad haven’t said whether or not she took the medication c)the medication was thought to cause problems for the fetus, thus, a)if she took the medication, than she was not risking her life, she made the decision to follow through with the pregnancy even though she knew that it could cause the birth of a child with special needs and b)if this is true, the real issue here is not the risk such pregnancies pose to women’s lives (because the medication can treat the illness)but about fetal disability after the fact. I am curious to know whether Pam T didn’t take the medication or if she took the medication and then had her son anyway.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • paul-bradford

    You know, this ‘site never ceases to amaze me! Last night, when I was thinking about the Tebow ad, it occurred to me that there absolutely must be an OB/GYN in this fine country of ours who can relate a story where a woman was informed that she had complications to her pregnancy, was counseled to abort, decided, for ethical reasons, to try and bring the pregnancy to term, and died in the attempt. Now I notice this article. RHReality Check comes through again.


    It’s worthwhile to take note of the fact that neither Pam’s story nor Sarah’s story sheds any light on the Choice/Anti-Choice debate.  Both women had options. Both women made informed choices.  Neither woman could possibly know, ahead of time, what was going to happen.  These stories touch an even more vital issue than choice and that is the meaning of faith.


    How can you reconcile faith with reason and not come to the conclusion that God loves Pam and hates Sarah?  You’d better not come to that conclusion, however, because if you do you’re one very effed up girl or boy.  What’s compelling about these stories is the fact that everyone can relate — because they aren’t merely about abortion or pregnancy.  Anyone can identify with a situation where they received extremely bad news and had to make an important decision.  When we made the decision, did we take the needs and rights of other people into consideration?  Did we counter danger with faith, hope and love or did we succumb to fear?  Did we maintain a sense of joy?  From my perspective, these are the important questions; and they are questions that everyone — no matter what her/his religion or non-religion — has to face.


    What I want to point out, and it’s something that the Tebow ad neatly disguises, is the fact that there is no guarantee that God will reward ‘right’ behavior with a positive outcome.  Anyone who says She (He?) will is fooling themselves.


    We play for keeps in this life.  There’s no room for ‘fooling around’ when it comes to the really vital matters.  The best way to respond to the Tebow ad is to engage people in a serious discussion.  Thank you, RHReality Check, for advancing that discussion. 



    Paul Bradford

    Pro-Life Catholics for Choice

  • sexstudent

    How can you reconcile faith with reason and not come to the conclusion that God loves Pam and hates Sarah? You’d better not come to that conclusion, however, because if you do you’re one very effed up girl or boy.


    Is this really what you meant to say because I do not understand it. Are you saying god does love them both?

    I agree that Ms. Tebow does have the right to express her OPINION and her CHOICE. But she still made a CHOICE. A choice the pro-lifers want to take away from women. Why is that Christians act so un-Christ-like?

    "In America, each person is entitled to their own opinion, but each person is NOT entitled to their own facts" Marty Klein


  • crowepps

    I believe what Paul is trying to say is that using the type of ‘reason’ where God makes bad things happen to bad people, God must be angry with Sarah and therefore her child’s outcome was ‘bad’ and God must be happy with Pam because her child’s outcome was ‘good’.


    Setting aside the whole problem of whether Down’s Syndrome is ‘bad’ in and of itself and having no better purpose in life than becoming a football player is ‘good’, and ignoring the ancient conundrum of whether God’s anger with Sarah would be reasonably expressed by handicapping her ‘innocent zygote’ as consequence, I believe Paul prefers to use the ‘faith’ belief that God loves everybody and all the terrible things that happen are a working of some mysterious ‘Divine Plan’ where all the suffering has some point which we as humans don’t grasp.


    None of which, of course, has much to do with actual reason as in ‘intelligence interpreting actual reality’ but instead a lot more to do with the ego-driven superstition that ‘things that happen to human’s cannot possibly be due to random accident because we’re so special and important from the first moment of our existence’.

  • paul-bradford

    Hi SexStudent,


    What I always mean to say is this: Whether or not you believe in the existence of an actual deity is far less important than the question of what characteristics the deity you believe in or disbelieve in possess.


    Philosophers have proven, beyond any doubt, that God exists.  Philosophers have also proven, also beyond any doubt, that there is no god.  Are you following me so far?  Bottom line is that I don’t waste any time puzzling over the question of whether or not there is a god.


    What matters very much to me, however, is what kind of God people believe in.  That has genuine ramifications.  Believing that you will be rewarded for good behavior, or ‘right’ behavior, or believing that suffering is caused by bad behavior has real consequences in the real world.  Your beliefs matter because your behavior affects all of us.  Pam Tebow’s beliefs also matter.


    There are actual walking-around people who carry about in their heads beliefs which, if they were brought to their logical conclusion, would hold that God loves Pam and hates Sarah.  Those are dangerous beliefs and they are, sadly, very common.


    The Super-Bowl ad will contribute nothing to the debate about the sanctity of life.  It will do a great deal to support dangerous beliefs about the divine nature.  Those beliefs have an impact on your life whether or not you hold the opinion that God exists. 

    Paul Bradford

    Pro-Life Catholics for Choice

  • crowepps

    Creating God In One’s Own Image (Ed Yong/Not Exactly Rocket Science; Nov 30)


    For many religious people, the popular question “What would Jesus do?” is essentially the same as “What would I do?” That’s the message from an intriguing and controversial new study by Nicholas Epley from the University of Chicago. Through a combination of surveys, psychological manipulation and brain-scanning, he has found that when religious Americans try to infer the will of God, they mainly draw on their own personal beliefs.


    Psychological studies have found that people are always a tad egocentric when considering other people’s mindsets. They use their own beliefs as a starting point, which colours their final conclusions. Epley found that the same process happens, and then some, when people try and divine the mind of God. Their opinions on God’s attitudes on important social issues closely mirror their own beliefs. If their own attitudes change, so do their perceptions of what God thinks. They even use the same parts of their brain when considering God’s will and their own opinions.


    Religion provides a moral compass for many people around the world, colouring their views on everything from martyrdom to abortion to homosexuality. But Epley’s research calls the worth of this counsel into question, for it suggests that inferring the will of God sets the moral compass to whatever direction we ourselves are facing. He says, “Intuiting God’s beliefs on important issues may not produce an independent guide, but may instead serve as an echo chamber to validate and justify one’s own beliefs.”


  • crowepps

    Pope vs. Doctors: How New Vatican Orthodoxy Undermines Medical Ethics and Imperils Your Health


    Jacob M. Appel Bioethicist and medical historian Posted: February 10, 2010 05:31 PM


    Catholic hospitals, which boast a long and admirable history of caring for the seriously ill and indigent in the United States, have for many years finessed the challenges of serving two disparate and often incompatible masters. On the one hand, the nation’s 573 Church-run hospitals and their physicians are not permitted by Vatican policy to offer services or advice to patients when doing so violates Catholic teaching. In theory, prohibited activities range from providing abortions and assisting suicides to urging patients with HIV to wear condoms when engaged in unprotected sex or telling bipolar women on lithium to use contraceptives to prevent birth defects. On the other hand, these hospitals–which serve about one third of all patients in the nation–are also quasi-public institutions, and their physicians and nurses are bound by the same ethical obligations that govern all other members of their professions. They must obtained informed consent, honor patient autonomy, and offer medical care in line with the clinical standards of their colleagues at secular institutions. While a latent tension often exists between these competing allegiances, two recent developments relating to Church policy have set medical ethics and Catholic doctrine on an unfortunate collision course.


    The first of these disturbing Church salvos against mainstream medical ethics is to be found in the newly promulgated Directive 58 of the United States bishops’ body governing Catholic health care services. This edict states that, barring certain specific circumstances, such as imminent death, Church doctrine prevents competent patients from refusing artificial nutrition and hydration. William Grogan, a religious advisor to Cardinal Francis George of Chicago, explained to the media that death would have to be expected within two weeks for a patient to turn down a feeding tube. In other words, according to current Catholic teaching, a cancer patient in a coma with a life expectancy of four weeks must now be force-fed–no matter what his prior instructions stated and without regard to his family’s wishes. All comatose and vegetative patients will be required to accept nutrition and hydration indefinitely, even if they leave behind air-tight living wills objecting to such "heroic" and invasive measures. This extreme policy apparently applies to all patients receiving care in Catholic-run hospitals, whether or not they are Catholic. Since United States courts have consistently accepted that mentally-competent patients have a right to refuse care if their wishes are clear and documented, these rules may well be illegal. However, even if Directive 58 is not a violation of the law, it is a gross breach of accepted standards of medical ethics. No doctor or nurse in the United States may provide such unwanted nutrition and hydration without defying a well-established code of professional conduct. It is likely that any provider who acted in this paternalistic and unequivocally immoral manner would lose his or her license. In the very least, the provider would become a pariah among his colleagues.


    A second Church-instigated challenge to medical ethics has arisen as a result of a grass roots protest by anti-abortion organizations in Pennsylvania against the well-regarded St. Mary’s Medical Center of Langhorne. In this case, Dr. Stephen Smith of St. Mary’s performed an ultrasound on an expecting mother and confirmed that the fetus had polycystic kidney disease, a fatal condition in infants. Smith recommended an abortion. When the pregnant women sought a second opinion, a midwife at Mother Bachman Maternity Center in nearby Bensalem, operated by the St. Mary’s, also recommended termination. The mother refused, which was certainly her prerogative, and the infant died two hours after birth. When local abortion opponents publicized Smith’s advice, a private citizen named Joseph Trevington demanded a formal review of St. Mary’s by the local archdiocese. The results of this ethics investigation are not yet publicly known, and may never be revealed, although a diocese spokesman stated that changes in the hospital policies are to be expected.


    The very decision to conduct such a moral audit displays a chilling new direction in Church practice. As a matter of doctrine, Catholic hospitals require employees to "respect and uphold the religious mission" of their institutions as "a condition for medical privileges and employment." So, in theory, any physician endorsing abortion (or vasectomies, birth control, withdrawal of life support, etc.) while on the hospital premises should be relieved of his duties. As a matter of Catholic doctrine, Trevington and his anti-abortion brethren appear to have the better half of the theological argument, at least when it comes to consistency and the letter of the law. At the same time, allowing Church dogma to dictate the medical practices of physicians clearly violates the most basic tenets of healthcare ethics. Dr. Smith had a duty to offer advice to his patient based upon his best independent professional judgment–which he apparently did. The Hobson’s choice that he faced–either to follow the Catholic "law" enshrined as policy or to adhere to medical obligation–was unreasonable and unacceptable.


    Both of these events expose the dark and unspoken (although widely understood) secret that enables Catholic hospitals to practice first-class medicine: Official Church policy on matters such as contraception and end-of-life care, like much Catholic doctrine more generally, is largely honored only in the breach. I have known many excellent physicians over the years, both religious and secular, who work at Church-run hospitals. All of them advise women taking medications that cause birth defects to use contraception and tell HIV-infected patients to use condoms. Many offer direct counseling on abortion, certainly when fetal prognosis is grim. I cannot imagine any of these gifted doctors would force-feed an unwilling cancer patient in violation of an advance directive or a health care proxy’s wishes. Much like the absurd loyalty oath that New York’s college professors–myself included–take to uphold the state’s constitution, any pledge to support Catholic doctrine on medical matters is broadly viewed as a formality to be agreed to and then summarily ignored. Historically, the Church has looked the other way. Now, by challenging this longstanding system of benign neglect, bishops and grass roots zealots may believe they will achieve ideological purity. What they are actually doing is jeopardizing both the welfare of Catholic hospitals and the public health.


    Some concrete thinkers may argue that since Catholic hospitals are "private" institutions, the Vatican can impose any rules that it wants. The claim belies the inherently public nature of the American hospital system. Catholic hospitals–like virtually all other hospitals in the Unites States–are only able to function as a result of a swath of government handouts and subsidies. Medicare and Medicaid pay the bills of almost half their patients. Federal funding supports the salaries of their medical residents. NIH Grants sponsor their research and clinical care. Many of the hospital buildings themselves were erected will federal construction dollars providing by the Hill-Burton Act of 1946. Private businesses may have a claim to considerable leeway in formulating their own rules and policies–although even "mom & pop" stores are reasonably prevented from excluding African-American customers and are often required to accommodate disabled shoppers. In theological matters, the Pope is certainly free to issue any decree he likes and those who wish to follow his dictates are entitled to do so. In contrast, Catholic hospitals function as public entities that serve people of all faiths and traditions. A patient in a medical emergency is taken by ambulance to the nearest hospital, not the nearest hospital that shares his social values. A system that operated otherwise would lead to logistical chaos and increased mortality. Once one accepts the premise that Catholic hospitals are public institutions, they have a moral obligation to comply with generally accepted standards of patient care and professional ethics. Today’s hospitals are far more Caesar’s than they are God’s.


    One of the greatest triumphs of modern health care in the United States is the rise of nonsectarian service. In an earlier era in New York City, for example, Jews sought care at Mount Sinai while Protestants preferred Presbyterian Hospital and Catholics chose St. Vincent’s. Now, most patients–and all wise ones–choose their health care providers for clinical skills and personal attributes, not religious labels. As a result, the majority of patients at Catholic hospitals are not Catholic. To impose orthodox Catholic doctrine on these non-Catholic individuals at the most vulnerable moments of their lives would be the most significant Church intervention in the lives of non-adherents since the Inquisition. Doing so would also threaten the ability of physicians to practice at Catholic hospitals without violating their professional codes of ethics. In light of these developments, any patient currently receiving care in a Catholic-run hospital should immediately clarify with her doctor whether this physician will follow the patient’s own end-of-life wishes regarding so-called heroic measures if they come into conflict with Directive 58.


    The Catholic Church has every right to announce and publicize its views on certain medical interventions and to declare that Catholics who engage in certain conduct are violating the rules of the Church. It’s the Pope’s club. He can make the by-laws. He does not have any business imposing such rules on third parties who do not wish to follow them. It will be a sorry day if American patients seeking the best medical care are forced to avoid Catholic hospitals for fear of having their living wills ignored or their doctors’ counsel dictated from Rome. The Church would be wise to focus its energies on theology and to leave the practice of medicine to the professionals.