Shaky out­look

Ro­man Catholic health­care be­ing dragged down by in­flex­i­bil­ity

Modern Healthcare - - OPINIONS EDITORIALS -

One of the more in­ter­est­ing re­li­gious groups in U.S. his­tory was what is com­monly known as the Shak­ers. Founded in the 18th cen­tury, the communal group es­tab­lished it­self in the Amer­i­can colonies, pre­par­ing for God’s will to be done on earth. Most peo­ple know them for their mu­sic and fur­ni­ture, which stress sim­plic­ity. They also en­cour­aged celibacy, viewing sex as the root of much evil since the time of Adam and Eve. That strict ad­her­ence to celibacy is one of the main rea­sons why there are al­most no Shak­ers left in mod­ern Amer­ica.

Watch­ing the trou­bles of Ro­man Catholic health­care to­day, you have to won­der if Catholic hos­pi­tals might also be on a be­lief-in­duced path to ex­tinc­tion. Con­tro­ver­sies over abor­tion and re­pro­duc­tive health have roiled many of these fa­cil­i­ties in re­cent years. Now, the Catholic bish­ops are ob­ject­ing to re­quire­ments in the health­care re­form law that in­sur­ance plans make con­tra­cep­tive cov­er­age avail­able to ben­e­fi­cia­ries. The cler­ics, joined by some con­ser­va­tive politi­cians, in­sist that this is a vi­o­la­tion of the con­sti­tu­tional right to free­dom of re­li­gion.

That last claim is de­bat­able, and there is a sub­stan­tial line of court and ad­min­is­tra­tive de­ci­sions that sug­gest re­li­gious ex­emp­tions from gen­eral laws must be more nar­rowly drawn.

While the Catholic Health As­so­ci­a­tion and other Catholic or­ga­ni­za­tions have shown some flex­i­bil­ity on these is­sues, the bish­ops have dug in their heels and tried to draw broad ex­emp­tions from re­pro­duc­tive rules. The bish­ops ap­par­ently don’t—or won’t—com­pre­hend that hos­pi­tals aren’t churches. If the Catholic Church sets down re­quire­ments for its clergy and fol­low­ers within its closed so­ci­ety, that is one thing. But mod­ern hos­pi­tals serve larger com­mu­ni­ties in­clud­ing a wide range of re­li­gions. They em­ploy large num­bers of nonCatholics or Catholics who don’t sub­scribe to all the be­liefs of the bish­ops. They op­er­ate in in­ter­state com­merce, tak­ing in and spend­ing bil­lions of dol­lars. They take huge amounts of money from a va­ri­ety of gov­ern­ment pay­ers, in­clud­ing Medi­care and Med­i­caid. They re­ceive tax ex­emp­tions on the con­di­tion that they pro­vide needed health ser­vices to their com­mu­ni­ties.

For bet­ter or for worse, Catholic hos­pi­tals are very much liv­ing in the sec­u­lar world.

Early last year on this page, we wrote about the decision by Bishop Thomas Olm­sted to strip St. Joseph’s Hospi­tal and Med­i­cal Cen­ter in Phoenix of the right to call it­self a Catholic fa­cil­ity. The bishop ob­jected to sev­eral al­leged re­pro­duc­tive-re­lated in­frac­tions there, most promi­nently the hospi­tal’s decision to per­form an abor­tion to save the life of a woman who, in the judg­ment of doc­tors, al­most cer­tainly would have died if she had con­tin­ued with an 11-week preg­nancy. An ethics panel con­cluded that the abor­tion would be con­sis­tent with church teach­ings, but Olm­sted dis­agreed and de­clared a nun who served on the panel ex­com­mu­ni­cated.

We said this raised a host of eth­i­cal and le­gal is­sues and might prove to be a wa­ter­shed in Catholic hospi­tal his­tory. It was. In Jan­uary, Catholic Health­care West, with which St. Joseph’s was af­fil­i­ated, dropped its for­mal ties to the church (Jan. 30, p. 6). Lawrence Singer, di­rec­tor of the health law and pol­icy cen­ter at Loy­ola Univer­sity of Chicago, then asked “Are we get­ting to a point where ei­ther gov­ern­ment pol­icy in the Af­ford­able Care Act or com­mu­nity de­mand for cer­tain ser­vices is such that Catholic health­care providers won’t ef­fec­tively be able to com­pete or serve their mar­ket any longer?”

A good ques­tion. Catholic health­care in­sti­tu­tions must an­swer it and per­haps de­vise dif­fer­ent strate­gies if they are to avoid the fate of the Shak­ers.


Man­ag­ing Ed­i­tor

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