End-of-Life Choice, Palliative Care and Counseling

Posts TaggedEthical and Religious Directives

Ashland Hospital Merger Runs Into Scrutiny

Mail Tribune
September 15, 2012


A patient’s right to choose whether to have an abortion or receive aid in dying are “important” issues to Ashland residents, Mayor John Stromberg said during Friday’s forum on a possible partnership between Ashland Community Hospital and Dignity Health.

Several of the nearly 100 people who attended forums Thursday and Friday expressed their concerns over Dignity Health’s stance against the Oregon Death with Dignity Act and banning direct abortions unless the mother’s life is at risk.

Stromberg said he thought Dignity Health’s presentation was well done.

“I thought they made a serious effort to be forthright and not dodge any of the tricky issues,” Stromberg said. “It’s a very important, big decision for us. We also have to consider that we’re in the position with a hospital (ACH) that is not stable, and something has to be done.”

Unreimbursed costs associated with treating Medicare and Medicaid patients, other unpaid medical bills and charity care contributed to a $2.5 million loss last fiscal year for ACH. The hospital also posted a $1.5 million loss on operations during the 2008-2009 fiscal year.

ACH Chief Executive Officer Mark Marchetti said a partnership would strengthen the hospital’s ability to compete with larger hospitals in Medford and increase revenue and patient services.

“We can help Ashland get back on its feet — not only survive, but thrive,” said Peggy Sanborn, Dignity Health’s vice president of partnership integration.

Sanborn said Dignity Health has identified ways to bring ACH into the black and increase its services.

Dignity Health and ACH have signed a memorandum of understanding to the potential merger, but a definitive agreement will have to be signed before anything is official.

Because the hospital operates under a long-term lease with the city of Ashland, the City Council will have a say in approving the partnership.

“The decision is going to be made by the council, and we’re all going to take part in diligent conversation before it’s made,” Stromberg said. “I am going to be prepared to vote, but I try not to express opinions ahead of time.”

The mayor only votes to break a tie.

“I heard it loud and clear,” said City Council member Carol Voisin. “Death with dignity and abortion are serious issues that the community thinks our hospital should be able to address and perform.”

Stromberg and Voisin were the only council members at either meeting, and Voisin attended both.

If a merger is formed between Dignity Health and ACH, its working physicians would not be able to prescribe patients who qualify under the Oregon Death with Dignity Act medication that induces death upon ingesting, said Carol Bayley, Dignity Health’s vice president for ethics and justice education. More

How the Catholic Church Misunderstands Death With Dignity

By Wendy Kaminer
The Atlantic
September 17, 2012

My father, a lifelong atheist, died at 91 in a Catholic hospice center. He received excellent, compassionate care from his nurses and from a doctor who willingly administered the morphine needed to ease his suffering — although, she advised, it would hasten his death. Did she violate the doctrine of a church actively opposing a Death with Dignity proposal now on the ballot in Massachusetts?

The medical team was administering palliative care, not assisting in a suicide. According to a Church spokeswoman, “You can have whatever level of morphine you need to control the pain, even if that level of treatment hastens death.” Palliative care is “legitimate,” even when it risks “shortening life,” Cardinal Sean O’Malley explains — so long as “the intent is not to hasten death, but only to ease the pain of a dying patient.”

I guess God knows the intent of every physician who administers pain medication to terminal patients, but law enforcement officials can’t be expected to know it. And sometimes, palliative care involves not just “the risk of shortening life” but the knowledge that it will shorten life. What if the only way to ease pain is to shorten life? More

Ashland Hospital Forum Dominated by Questions on End-of-Life, Abortion

Mail Tribune
September 14, 2012


Some of Ashland Community Hospital’s policies will change if a partnership is formed with Dignity Health, representatives from the hospital system said Thursday night.

Physicians at an ACH run by Dignity Health would not be able to prescribe patients who qualify under the Oregon Death with Dignity Act medication that induces death upon ingesting, system officials told about 45 people at the first of two forums on the possible merger.

“If the physician is on our dime “… the thing that the physician cannot do is write the prescription and hand it to the patient,” said Carol Bayley, Dignity Health’s Vice President for Ethics and Justice Education.

Currently, ACH has “no policies that dictate the issue one way or another,” said Mark Marchetti, ACH chief executive officer.

Marchetti had said Wednesday that the end-of-life care its patients receive will not change if a partnership is formed with Dignity Health; but, according to Bayley, it will. More

End-of-Life Care Reassurance as ACH Considers Its Dignity Deal

Ashland Daily Tidings
September 13, 2012


Ashland Community Hospital officials insist the end-of-life care its patients receive will not change if a partnership is formed with Dignity Health.

Physicians at ACH can prescribe patients who qualify under the Oregon Death with Dignity Act medication that induces death upon ingesting, said Mark Marchetti, ACH chief executive officer. “We have no policies that dictate the issue one way or another,” Marchetti said. “We certainly don’t monitor our physicians’ prescribing.”

The hospital’s physicians can discuss the option of self-administered death with patients, he said.

Many of ACH’s physicians have made the personal and legal choice to not prescribe aid-in-dying medications, Marchetti said, “because that’s their personal philosophical position.”

Patients who are part of ACH’s Hospice Program, which cares for those diagnosed with illnesses that likely will kill them within six months, can discuss the option of self-administered death with hospice nurses and social workers as well, he said.

The Hospice Program’s nurses and social workers “refer them to their own physician and continue to provide the hospice services … and we’re even willing to be there while they take the drug,” Marchetti said. “We don’t participate.”

The Oregon Death with Dignity Act requires a patient who opts for aid in dying to administer the life-ending drug independently.

Jason Renaud, a representative from Compassion & Choices of Oregon, said he is concerned ACH’s policy will change if a partnership is formed. More

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.