Shaky outlook

Roman Catholic healthcare being dragged down by inflexibility

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 non-Catholics 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). 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.



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