End-of-Life Choice, Palliative Care and Counseling

The role of faith in health-care deliveryby Jay

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By Monica Harrington, Deborah Oyer and Kathy Reim
The Seattle Times
February 10, 2012

AS America becomes more multicultural, it’s time to re-examine the role of faith in health-care delivery. This has become an issue because consolidations and mergers have resulted in a situation in which nearly 18 percent of all hospitals and 20 percent of all hospital beds in health systems nationwide are owned or controlled by the Catholic Church.

In some isolated areas, the only hospitals available are Catholic-run. Non-Catholics are increasingly finding themselves in situations in which the only health care available is subject to care restrictions dictated by the Catholic hierarchy.

On San Juan Island, for example, the hospital now being built will be the only hospital in a region that is geographically isolated. The hospital, which is being built and supported with taxpayer dollars, will be run by PeaceHealth, a Catholic organization. In keeping with its Catholic belief system, PeaceHealth forbids abortions and physician-assisted suicide, something that likely will come as a surprise to the more than 72 percent of San Juan County voters who supported the state’s “Death with Dignity” initiative in 2008.

Meanwhile, in King County, the largest health nonprofit, Swedish Medical Center, has deepened its partnership with Providence, a Catholic-owned and -managed health-care system that includes 27 hospitals across five states. Already, Swedish is changing its policies out of “respect” for its financial partner. The upshot is that Swedish will no longer do “elective” abortions, will begin financially segregating tubal ligations, and will answer to a “superboard” that is dominated by Providence appointees.

As the Catholic Church has been widening its influence and reach in American health care, it also has been flexing its muscles in health-care policy. Recently, it asserted that it should not have to provide contraception coverage to employees at church-run hospitals or universities around the country even when those employees are not Catholic, and when a large share of their salaries are paid for by tax dollars that flow through broad-based medical programs such as Medicare and Medicaid.

Moving beyond health care, the Catholic Church is also asserting its influence in ways that seek to expand religious-freedom protections to include the freedom to take broad-based taxpayer money and then spend that money in a manner that discriminates against Americans who don’t accept Catholic theology.

In Illinois, for example, the church recently asserted that its First Amendment right to freedom of religion is being compromised when its own discriminatory policies against gays make it ineligible for government contracts to find adoptive homes for children in need among well-qualified families, gay or straight.

In making these claims, the Catholic Church is seeking to transform a right that is vitally important — the freedom of people to decide for themselves which religion to follow without government interference or sponsorship — into a right for government support and funding for theology-based program implementation.

It’s one thing to say that because you’re using private funds, you don’t have to provide services that violate religious conscience. It’s another to accept public money in a market situation where “customers” don’t have free choice, and make that same assertion.

In a perfect world, patients would have full knowledge of whether the system they choose is compatible with their religious experience and beliefs. But in practice, this doesn’t happen. Hospitals and care providers aren’t required to disclose anything about their religious preferences, and so patients and families have to make decisions, often in traumatic or even life-or-death situations, without knowing anything about which religious preferences will guide their care.

A woman of childbearing age should know whether the doctor and medical facility she’s choosing would honor her right to terminate a pregnancy. (Let’s remember that a bishop in Arizona said it was wrong to terminate a pregnancy to save the life of the woman and that view was later endorsed by the U.S. Conference of Catholic Bishops, which oversees all Catholic health-care facilities.)

Likewise, a dying elderly man should have the right to know that if his end-of-life care instructions are compatible with state law, they will be followed.

What’s needed here in Washington state is a Patient Bill of Rights that makes clear that the religious preferences of the patient are paramount.

As part of this, providers that take state tax money should be required to disclose any religious-based policies that restrict patient-care options, and provide reasonable accommodation to ensure the religious-freedom rights of all patients are protected.

In nonemergency situations where patients have multiple options, disclosure and transparency might be enough. However, emergency rooms and hospitals supported through public taxing districts (as the new hospital on San Juan Island is) should be required to make available evidence-based care unrestricted by religious theology so that patients themselves can make choices about which care and services fit within the context of their own religious beliefs.