End-of-Life Choice, Palliative Care and Counseling

Posts TaggedCatholic hospital

Bishops Step Over the Line

Over and over we see the U.S. Conference of Catholic Bishops confuse the right to exercise their religion with a right to impose their religion on Americans who don’t share it. This is not a subtle difference.

And, as Bill Moyers points out in the context of their intransigence on access to birth control, the bishops aren’t content with an exception from the rule that, like other employers, they provide birth control coverage to workers in their hospitals and universities. They also want to be able to keep their employees from obtaining birth control pills from a third-party insurer, at no cost to themselves.

This stance grossly abuses the rights and privileges of American business owners. Let’s face it: Hospitals are money-making operations, dominant in the economy and relying in great measure on government Medicare contracts and employer-based health plans. To allow one very large employer to dictate private healthcare decisions of its employees would distort the American ideal of freedom of religion into a very un-American practice of religious tyranny. The bishops want to control everyone’s moral decisions, Catholics and non-Catholics alike.

In the context of end-of-life choice, the bishops enforce Ethical and Religious Directives for Catholic Healthcare. This document instructs doctors to ignore advance directives that conflict with Catholic moral teaching (ERD #24), requires patients in permanent vegetative states to overcome a presumption in favor of indefinite tube feeding (ERD #58), disallows as “euthanasia” a patient’s refusal of treatment such as kidney dialysis if intended to advance the time of death (ERD’s #59 and 60), and urges employees to offer religious teaching on the redemptive power of suffering when standard comfort care fails (ERD #61).

With regard to Oregon and Washington’s Death with Dignity Acts, the bishops use the machinery of Catholic healthcare to withhold information and support for aid in dying, a legal end-of-life choice. Catholic hospitals, hospices and healthcare systems in those states often impose a draconian gag rule on their employees to deprive patients in their care of comprehensive knowledge of end-of-life choices. As noted by Crosscut and The Seattle Timesthe Sisters of Providence healthcare system imposed policy that employees can’t discuss the issue with patients, even if asked. In response, Steven Saxe, director of the state’s Office of Health Professions and Facilities, reassured healthcare workers that all healthcare providers, including those at Providence, have a “protected right to offer basic information” about the law to patients.

An oppressive gag rule not only violates a cardinal rule of informed consent in healthcare, it also tramples the free speech rights and professional ethics of hospital employees and physician contractors.

As with contraception, a free society must find the middle ground. Catholic Bishops must be free to exercise their religion, yet we cannot allow them to deny that same freedom to the rest of us.

Good News From Kentucky!

2011 closed with good news out of Kentucky. On Friday Governor Steve Beshear refused to approve a Louisville hospital merger that threatened patient choice. Compassion & Choices, MergerWatch, the National Women’s Law Center and other national advocacy organizations joined local activists to raise constitutional and public policy questions regarding potential threats to end-of-life and reproductive care. In announcing his decision, Gov. Beshear noted “significant legal and policy concerns.”

Religious doctrine limits patient choice in over 600 of our nation’s hospitals, nursing homes and HMOs. When a Catholic healthcare institution merges with a non-sectarian one, the Ethical and Religious Directives for Healthcare (ERDs) invariably control care provided by the merged entity. Compassion & Choices is committed to joining patient rights advocates to oppose the imposition of religious restrictions wherever the threat arises.

This proposal ceded control of Louisville’s only public hospital to a Catholic healthcare company (St. Joseph Health System), and placed healthcare decisions in the hands of the local bishop and the United States Conference of Catholic Bishops. We applaud Governor Beshear for exercising good stewardship and ensuring that University Hospital (UNL) serves the public interest and needs for future generations of Kentucky citizens. “If this merger were allowed to happen,” Beshear said, “UNL and the public would have only indirect and minority influence over the new statewide network’s affairs and its use of public assets.”

Despite assurances from architects of the merger, loss of public influence in healthcare could have disastrous consequences for the people who depend on publicly funded healthcare. The people could never again rely on their public institution to place the highest priority on community needs. The ERDs that govern Catholic healthcare enforce Catholic doctrine. Staff and administrators must balance that doctrine, when possible, with community needs. Some options remain forbidden, no matter how great or pressing the need may be. This balance can leave the community with uncertain and unpredictable service.

A doctor at St. Joseph Hospital – a defender of St. Joseph’s Catholic identity – wrote of the confusing and contradictory statements made by hospital officials:

An Oct. 24 (Louisville) Courier-Journal article noted that on June 14, U of L Dean Halperin, “made a promise that we’ll respect the ERDs of the Catholic Church,” and on June 30, University Hospital CEO James Taylor stated, “we’ve also made the commitment that by joining the network with (SJHS) … we will adhere to the ERDs.”

Now that a merger might be imminent, a different stance has surfaced. The merger partners state in an Oct. 19 Metro Board of Health (BOH) release that University Hospital “will not become a Catholic hospital and will not be required to follow the ERDs.”

The Courier-Journal calls this “legal mumbo-jumbo.” Nonetheless, University Hospital spokesman David McArthur would not concede that it was a position change, but “an evolution of our explanation.”

Without governing authority, UNL and the citizens it serves could be forever tossed like a kite upon the changing winds of “evolving explanations” and changes in Church policy. In recent decades, the Vatican has become more conservative and U.S. bishops have required stricter obedience from Catholic healthcare institutions. No one can predict how Catholic doctrine or enforcement may change in the future, and once a public institution is lost, its accountability to the public welfare is lost forever.

So we welcome the new year with a celebration of effective community advocacy and a toast to elected officials who act in the public interest. Kentucky Reps. Mary Lou Marzian and Tom Burch helped inform the governor of advocates’ concerns and urged him to stand up for all Kentucky residents and their right to comprehensive healthcare.

We remain watchful. Announcing his decision, the governor said “… I have determined that this proposed transaction is not in the best interest of the commonwealth …” The emphasis was his. Compassion & Choices will resist any proposal – in Kentucky or elsewhere – that fails to safeguard patient rights to a full range of end-of-life healthcare choices