End-of-Life Choice, Palliative Care and Counseling

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The Bishops’ Politics: Why Are Women’s Health and Lives Subject to The Catholic Lobby?

By Imani Gandy
RH Reality Check
June 18, 2012

Many of the religions practiced in the United States support a woman’s right to access reproductive health care, including abortion and contraception, as a matter of free exercise of conscience.  The Catholic Church is the one of the few, if not the only religion that is fundamentally antithetical to any notion of women’s reproductive health, freedom, and justice. Unfortunately, the Catholic Church as represented by the U.S. Conference of Catholic Bishops, more than any other, directly influences American politics.

Take, for example, the controversy that has been raging for the past four months about President Obama’s contraception mandate. After Republicans lost their collective mind about access to contraception, whinging that President Obama was destroying the Constitution and the very fabric of society as we know it by daring to include women’s reproductive health under the rubric of the Affordability Care Act, President Obama offered an accommodation to religiously-affiliated employers that protested being required to offer birth control coverage as part of their insurance plans. The accommodation will allow such religiously-affiliated employers not to offer birth control; instead, insurance companies for those employers will have to reach out directly to employees and offer contraception coverage for free, without going through the employer.  Writing about the accommodation, Amanda Marcotte noted that Obama had punked the GOP: “Obama just pulled a fast one on Republicans. He drew this out for two weeks, letting Republicans work themselves into a frenzy of anti-contraception rhetoric, all thinly disguised as concern for religious liberty, and then created a compromise that addressed their purported concerns but without actually reducing women’s access to contraception.”

In February – when Obama announced the accommodation – two entities on opposite sides of the birth control issue  (Planned Parenthood and the Catholic Health Association) were satisfied.  Sister Carol Keehan, the president and CEO of the Catholic Health Association (“CHA”), noted, “The Catholic Health Association is very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions.”  She further noted that the accommodation adequately responded to the concerns of the CHA: “The framework developed has responded to the issues we identified that needed to be fixed. We are pleased and grateful that the religious liberty and conscience protection needs of so many ministries that serve our country were appreciated enough that an early resolution of this issue was accomplished. The unity of Catholic organizations in addressing this concern was a sign of its importance. This difference has at times been uncomfortable but it has helped our country sort through an issue that has been important throughout the history of our great democracy.”

Four months later, however, the CHA has reversed its position in what can only be described as a flip-flop of epic proportions.  On Friday, the CHA sent a five-page letter to the Department of Health and Human Services stating that the accommodation no longer “adequately meet[] the religious liberty concerns.”  Odd — that wasn’t CHA’s position four months ago.

Nonetheless, the CHA now claims that the contraception mandate — which exempts actual houses of worship, but not faith-based institutions like hospitals and schools that don’t primarily serve or employ people of the Catholic faith – should be further restricted, and that the exemption should be broadened to include hospitals and schools.  Plainly, it is a purely political move.  As Michelle Boorstein notes, the CHA’s about-face comes as just as polls show that Romney and Obama are tied among Catholic voters. (Four out of the five last presidential elections were won with the Catholic vote.)

Given that the U.S. Conference of Catholic Bishops and organizations like the Catholic Health Association play a critical role in American politics, the question becomes, then, for how much longer are we going to permit religion to have a place in our political discourse?  And, at what point does the health and safety of American women become paramount to any issues of religious conscience?  There is a clear and present danger that the health of American women – especially the health of minority and low-income women – will be subject to the political whims of the Catholic Church.

One stark example of this unholy union of political and religion is the increasing number of mergers between secular and Catholic hospitals.  Hospitals throughout the country are struggling to remain solvent. As hospitals face increasing financial difficulty, mergers between secular and Catholic hospitals seem to be an oasis in a desert plagued by financial uncertainty. Certainly, such mergers seem to be a solution more desirable than closing hospitals. But at what cost?

Catholic hospitals are required to obey the U.S. Conference of Catholic Bishops’ list of ethical and religious directives.  Often when Catholic hospitals merge with secular hospitals, the secular hospital is thus required to obey the ethical and religious directives of the Catholic Health. This means that many women’s healthcare services are no longer offered at the newly-formed hospital. Such services including abortions (even those that are medically necessary), birth-control, vasectomy and tubal ligation, and many kinds of infertility treatment. Additionally, Catholic hospitals specify how ectopic pregnancies must be treated, and that treatment differs from how they are treated in secular hospitals.

Such restrictive rules have a catastrophic effect on women in communities where the only option may be to obtain healthcare services at a newly merged hospital which finds itself suddenly required to follow Catholic religious and ethical directives or risk severe punishment.  For example, in 2009, the ethics committee of St. Joseph’s Hospital and Medical Center, a hospital in Phoenix operated by Catholic Healthcare West, Phoenix voted to permit a medically necessary abortion to save the life of a woman (11-weeks pregnant) whose pulmonary hypertension would have killed her if she did not have an abortion. That hospital was later stripped of its Catholic access, and Margaret McBride, a nun on the ethics committee was automatically excommunicated — all because of a decision that almost certainly saved the life of a breathing already-alive woman. (As of December 2011, McBride has been returned to good standing, and is no longer excommunicated.)

The impact of the merger between Catholic and secular hospitals disproportionately and negatively impacts women, and in many cases, the merger debate becomes about whether a community is willing to sacrifice the health of women in order to promote economic and community growth or ensure that hospitals remain solvent.  Such debates arise when a community attempts to merge a secular and Catholic hospital so that the newly-formed hospital can remain in compliance with religious and ethical directives while still offering “sinful” women’s health care services.

But even when such creative solutions are proposed, those solutions may not entirely assuage the fears of women’s health activists.  For example, in Waterbury, Connecticut, a proposed hospital merger between two hospitals has sparked grave concerns among those who insist that the continuation of reproductive healthcare services must be a priority.  St. Mary’s and Waterbury hospitals, and a for-profit company, LHP Hospital Group, plan to build a new 800,000 square-foot private hospital at a cost of $400 million, with each hospital having a ten percent stake. Additionally, the hospital seeks state approval for a separate “ambulatory” center which would be located near, but not inside the new hospital.

As Teresa Younger, the executive director of the Connecticut Permanent Commission on the Status of Women points out, “the agreement by LHP and Waterbury Hospital to follow the ethical and religious doctrines for a ten-percent owner of the facility is problematic.”  Moreover, it I questionable as to whether requiring women who have undergone a C-section to visit a separate facility for a tubal ligation comports with the best “standards of practice.”

Mergers like the one being debated in Waterbury are occurring nationwide, and it seems that the health of women – many of whom are not Catholic in the first place – is being sacrificed at the behest of the Catholic Church.  It is unacceptable. The tension between religious doctrine and women’s health should always be resolved on the side of women’s health, especially where, as here, the decision-making process of Catholic leaders seems entirely political and not conducted in good faith.

The Demise of the Catholic Hospital Brand

It used to be Americans viewed Catholic hospitals and healthcare systems with universal respect and trust. They had no reason to do otherwise.

Founded in the nineteenth century by orders of nuns with a mission to care for the poor, Catholic hospitals grew and thrived in modern industrial medicine. Many became conglomerates and dominant sources of healthcare in cities and towns throughout the nation, especially in the Western United States. The trade association founded in 1915, the Catholic Health Association today represents 1200 Catholic health care sponsors, systems, facilities, and related organizations and services. Catholics and non-Catholics alike have considered Catholic Healthcare an unqualified good, delivering high quality medicine and serving their communities’ needs. It made little difference to most people whether their hospital was Jewish, Seventh Day Adventist, Episcopal or secular. Indeed, the image of selfless nuns running charitable institutions probably bestowed a brand advantage on the Catholic entities.

This is no longer the case.

A conservative theology and obsession with obedience have ruined the brand. Nowadays the phrase “Catholic hospital” is as likely to conjure images of unyielding bishops enforcing dogma on the irreligious as kindly nuns delivering succor to the suffering. Today most people realize that very few nuns actually run or work in Catholic hospitals. Knowledgeable people also know Catholic hospitals deliver no more charity care than their secular nonprofit counterparts.

Change came gradually, but high-profile power plays by the bishops recently pushed the brand onto a steep downward slide.

Activist Bishops

1. Two years ago Phoenix Bishop Thomas Olmsted excommunicated a prominent nun for allowing doctors to save a woman’s life by terminating her pregnancy. When the hospital stood by the decision not to let both mother and fetus die, Olmsted stripped the entire medical center of its Catholic affiliation. National commentators openly warned women with reproductive emergencies to avoid Catholic hospitals.

2. In February 2010 Bishop Robert Vasa revoked Catholic affiliation for St. Charles Medical Center in Bend, Oregon for providing tubal ligations in keeping with prevailing medical standards for the procedure.

3. The Catholic Health Association supported its member hospitals until the bishops extracted an admission that local bishops are the “authoritative interpreter” of permissible Catholic healthcare. The Association’s CEO publicly affirmed absolute power for local bishops to interpret the ERDs (Ethical and Religious Directives for Catholic Healthcare) and even to develop their own if they choose.

4. Last year a bishop in Spain declared the decision to remove food and water from a 90 year-old comatose woman an act of euthanasia. Describing the vegetative states as a chronic illness, he objected to laws allowing the family to follow what they knew to be her wishes.

5. Last June the US Conference of Catholic Bishops met in Seattle, reproached Compassion & Choices by name and denounced aid in dying as an end-of-life choice. Defying logic, the Conference asserted that adding a choice actually restricts choice and creates an illusion of freedom. More to the point of doctrinal enforcement, they called aid in dying “a grave offense against love of self” that breaks the bonds of love with God.

Blocked Expansion

Aggressive enforcement of dogma did not go unnoticed in communities where Catholic Hospitals sought to acquire or merge with secular ones. Entities resulting from unification with a Catholic hospital are always obligated to adhere to Catholic teaching and follow the bishops’ instructions for Catholic healthcare.

1. Two years ago the citizens of Sierra Vista, Arizona demonstrated for months against the proposed takeover of a secular hospital by a Catholic healthcare system, until hospital officials dropped the proposal.

2. Early this year the Attorney General and Governor of Kentucky blocked a bid by Catholic Health Initiatives to merge with publicly funded University Hospital.

Demands of the Marketplace

The enormous significance of these events became evident when Catholic Healthcare West, the fifth largest hospital conglomerate in the nation announced termination of its status as a ministry of the Catholic Church.

Renamed Dignity Healthcare, the 50 hospital system seeks to acquire additional hospitals and triple its size. The CEO readily admits that concerns about Catholic affiliation hampered his ability to grow. At the time he said the change to a nondenominational board would create “a tremendous opportunity that will help accelerate our growth.”

Oregon is the first state Dignity targets for expansion. In a subsequent blog I will examine what this means for end-of-life choice in the town of Ashland, where Dignity seeks to acquire the community hospital.

The clear meaning of Catholic Healthcare West’s transformation to Dignity Health is that “Catholic” is no longer a desirable brand in the marketplace for healthcare partnerships and medical services.

Truer but Fewer

Visiting Ireland in April, I chatted with a Catholic monk as he showed us architectural details of a medieval church. He bemoaned the drastic changes underway as the government wrests control of 95% of the nation’s public schools from the hierarchy of the Church. But he acknowledged the change is necessary as the church has become more conservative and the state more leery of its control. I ventured the opinion that the Vatican’s radical conservatism hardly seems a strategy for long-term growth. “That’s not the point,” he said. “Church leaders value those of ‘truer’ faith,” and they don’t mind that this retains fewer truly faithful adherents.

If the same principle holds for Catholic hospitals in the United States, Americans take heed. Institutions that retain their Catholic affiliation and continue to embrace their ministerial role may be those most entrenched in Catholic moral teaching. Bucking imperatives of the market, they may be most inclined to apply the Ethical and Religious Directives strictly and hew narrowly to services and healthcare decisions the local bishop deems consistent with church doctrine. You can affirm, with our Sectarian Healthcare Directive, that no facility’s dogma should override your end-of-life choices, and I encourage you to do so. Because without vigilance, patients and doctors may have less influence than the bishop over healthcare decisions made inside their hallowed walls.

Everyday Elder Abuse

Tomorrow is World Elder Abuse Prevention Day. It’s a day to appreciate that elders in our society endure abusive behavior every day and to consider how we might remedy this deplorable situation.

We hear of instances in which families, caregivers or others physically assault or verbally abuse elders in their care. Whether these instances arise from criminal pathology, frustration or plain meanness, we should all be on the lookout for such abusers, report them to authorities and encourage punishment.

Compassion & Choices focuses on other forms of abuse — the ones most commonly and even routinely — inflicted on elders. These forms are rarely recognized as abuse and are never punished. I’m talking about the pain, torture and invasion of bodily integrity from “heroic” and futile medical procedures associated with end-of-life care.

Most elders in this nation die in acute medical facilities. Even those whose deaths are anticipated following a long battle with cancer, heart failure or lung dysfunction do not die in the peace of their homes. Even they, the long-time dying, must endure the cold mechanical interventions of intensive care. Often in violation of express wishes stated in an Advance Directive for Healthcare, our elders must bear insertion of tubes to measure arcane pressures, tubes to breathe, to siphon throats, to empty urine, to drain fluids, to administer food and fluids. They must submit to the constant clicking, humming, droning and ringing of the machines and alarms at their bedside.

Add to this scene severe and unnecessary suffering from inadequate treatment of pain. Add to this a rampant failure to acknowledge and palliate agonizing symptoms like breathlessness, itching, hiccoughs, nausea, dizziness, bedsores and draining wounds of surgery .

What emerges is a picture of widespread, systematic, Medicare-supported torture of our elderly, dying citizens. Shame, shame on us for using taxpayer’s money in this indefensible manner.

When an 85-year old man like William Bergman, dying of mesothelioma, moans in pain with every breath, as his daughter pleads with doctors to prescribe more effective pain medication, that is elder abuse. Compassion & Choices won a court judgment to that effect, the first of its kind, in 2001.

When an 82-year old woman like Margaret Furlong receives full cardio-pulmonary resuscitation in violation of her Advance Directive, and endures ten days of intensive care despite squeezing her son’s hand to communicate her desire to have her hands untied and machines discontinued, that is elder abuse. Yet when Compassion & Choices helped bring this case as elder abuse and failure to honor an advance directive, it was thrown out of court.

When medical providers encourage irrational hope in endless rounds of chemotherapy for advanced, end-stage cancer, that research indicates are unlikely to extend life but sure to degrade its quality, that’s elder abuse.

When institutions withhold vital information about medical practices like terminal sedation or aid in dying, which they deem immoral, and hold patients hostage to their own beliefs in the redemptive power of suffering, that is elder abuse, and abrogation of informed consent principles. Catholic facilities that enforce gag rules and bar conversations about legal aid in dying, even when a patient inquires, are doing just that in Oregon and Washington.

Compassion & Choices is not alone in naming such examples “abuse” and “torture” and citing them as human rights violations. International conventions, treaties and courts demonstrate an understanding of the veracity and gravity of such charges. Numerous internationally recognized principles address patient care and the right to bodily integrity.

The European Charter of Patients’ Rights for example sets out, “Each individual has the right to avoid as much suffering and pain as possible, in each phase of his or her illness. The health services must commit themselves to taking all measures useful to this end, like providing palliative care treatment and simplifying patients’ access to them.” Policies restricting opioid availability and causing patients to suffer unnecessary pain abridge the human right to be free of torture.

The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, has stated, “[E]very competent patient…should be given the opportunity to refuse treatment or any other medical intervention. Any derogation from this fundamental principle should be based upon law and only relate to clearly and strictly defined exceptional circumstances.”

This year, let’s acknowledge our national habit of over-treatment at the end of life for what it is: elder abuse, torture and a violation of human rights. Let’s stop withholding information, ignoring wishes and inflicting elders with futile, painful treatment and unnecessary pain and suffering. And certainly, let’s stop using Medicare taxes to pay for this national scandal.