ISSUE: This week in Grey Matters, we look at a trend in the healthcare industry where religious-affiliated groups are taking over public hospitals and applying their ethics and values. Specifically, is it ok for religious-affiliated hospitals to limit treatment options for patients ? Let’s examine this topic with a fictional story about Carol and Dr. Rodriguez.
BACKGROUND: “Can you believe that Emma is 3 years old now?” I asked Dr. Rodriguez, my ob-gyn for the past five years. She had delivered both my children by C-section.
“They grow up fast,” she said.
“And they’re fast while they’re growing up,” I said. “I’m having a hard time keeping up with Nathan. I turn my back for one minute, and he’s opened up every cabinet in the kitchen and has pots and pans everywhere.” I settled back on the exam table and rolled up my shirt.
“Your husband is gonna have to help out more,” Dr. Rodriguez said. “Especially after this one.”
She rubbed the cold lubricating jelly on my seven-month pregnant belly. “You’re almost 45, and it’s gonna be tougher for you to recover from the C-section.”
“Ron wouldn’t change a diaper with a gun to his head. We’re lucky to have both our parents nearby.”
Dr. Rodriguez rolled the transducer over my stomach. “Well, let’s take a look at the little one.” She stopped at one point and we both listened to the sound of the heartbeat. “The miracle of life,” she said and looked at the monitor. “You sure you don’t want to know the sex of the baby?”
“We like being surprised. Just tell me if everything is ok.”
“The baby looks perfect,” she said and started wiping off the gel off my stomach.
She consulted my chart and then made a few notes. “We should be able to schedule this for mid-August,” she said.
“This is definitely going to be our last one,” I said. “Ronnie is gonna be 50 this year, which will make him 72 when this kid graduates from college.”
“Probably best at your age,” she said and helped me sit back up.
“We talked about tubal ligation before I had Emma. I definitely want that this time.”
Dr. Rodriguez looked over my shoulder like there was someone behind me. “I won’t be able to do a tubal ligation on you.”
“What?” I asked. “Is there something wrong?” I’d been coming to her according to plan, monthly at first and recently every two weeks. Why hadn’t she mentioned this before? I felt the baby kick, and I felt weak in my stomach.
“Everything is fine with you and the baby,” she said and shrugged. “I just don’t perform tubal ligations anymore.”
“Why not? Are they dangerous? My sister had one just a couple months ago. I thought they were safe.”
“They are safe. Very limited risk. It’s just that I’m assuming you’ll be having your baby at St. Christopher’s Hospital.”
“Of course. That’ s the best hospital in town.”
“St. Christopher’s doesn’t allow tubal ligations to be performed anymore.”
“What?”
“The hospital is now part of the Catholic Health Association. They have to comply with the Ethical and Religious Directives of the Catholic Church.”
I couldn’t believe this. “So you’re saying that a bishop is now standing between you and me in terms of my healthcare?”
“The view of the Catholic Church is that they’re not providing healthcare if they intentionally interfere with someone’s reproductive system in a way that doesn’t address some injury or disease.”
“But I don’t want to have more children,” I said.
“There are other methods of birth control.”
“You and I discussed this at length the last time. Why can’t I have the form of birth control I want?”
“Different hospitals have different standards of ethics about what procedures they will or won’t perform.” Dr. Rodriguez said. “We don’t have a Burger King – have it your way – model of healthcare.”
“What would be wrong with that?” I asked.
“It would be too dangerous. What about a person with bodily integrity identity disorder?”
“I don’t even know what that is,” I raised my voice this time, and I could feel the baby kicking inside me.
“It’s a person with a perfectly healthy limb who wants it cut off because it doesn’t feel like it’s a part of his or her body. It feels like an appendage that doesn’t belong. Or a patient who wants a doctor to prescribe a lethal combination of drugs. Healthcare has been guided as much by a code of ethics and values – maybe more so – than by medical training. ‘Do no harm’ has been the standard since Hippocrates in the 5th century BC.”
“I’m not asking you to chop off an arm! I just want you to tie my tubes so I can’t get pregnant again.”
“It’s not something that the hospital allows.”
“Is there no way to have the procedure?”
“You can have your baby at the County Hospital.”
“But my husband, me, all my children. We’ve all been born at St. Christopher’s.”
“We can always have your baby at St. Christopher’s and then you can schedule the tubal ligation another time at a different hospital.”
“But isn’t it better to have it done while I’m out and all cut open?”
Dr. Rodriguez nodded. “That would be preferable versus having two operations with two recovery times.”
“Why would the board of St. Christopher’s let the Catholics take over?”
“The board made a good decision,” Dr. Rodriguez assured me. “The Catholic Health Association has really turned the hospital around. They’ve upgraded a lot of the imaging equipment, cut down ER waiting room times, and added a whole new program of palliative care to help people manage treatment of their illnesses. Overall, patient care is much better under the management of the CHA.”
“But they won’t let you do a tubal ligation?” I asked. Even though my morning sickness had stopped at fifteen week, I felt like I was gonna throw up. I couldn’t believe I had to switch doctors at this stage.
“Sorry,” Dr. Rodriguez said and left the room.
“Little one.” I rubbed my belly, like Ron used to do for me when I felt really nauseated. “I guess you’re gonna be born at County.”
COMMENTARY: Science and technology sometimes move so quickly that it’s good for this progress to be tempered by ethics and values. I don’t think that we should have a complete Burger King healthcare system where patients can order what they want from the increasingly broad menu of medical options. In this country, religion has been the base for our ethics and values since the beginning, and we are wise to listen to what religious leaders say about healthcare. But we have to balance that with a patient’s right to have full information about options.
One in six hospital patients in the United States visits a hospital affiliated with the Catholic Health Association, and the number of Catholic-affiliated hospitals is growing. When the church takes over the hospital, the church requires adherence to the Ethical and Religious Directives, established by the United States Conference of Catholic Bishops. These directives are reviewed regularly, with the 5th edition approved in 2009. The Catholic Hospital Association seeks to embody in their directives Jesus’ concern for the sick, and the directives contain some admirable goals, such as providing health care to those who cannot afford it. But the directives also take a very strict view on the affirmation of life from conception to death. And the directives strictly prohibit all forms of birth control and conception outside of intercourse (e.g., in vitro fertilization). This has resulted in instances similar to what Carol is going through where tubal ligation is not offered as part of a C-section. In even worse situations, rape victims are not presented all birth control options if those options affect the ability of a fertilized egg attaching (implanting) to the womb.
This is a difficult issue for me because I’m very uncomfortable as a man weighing in on the issue of women’s reproductive health. For that reason, I am disturbed that an all-male organization, such as the US Conference of Catholic Bishops, sets policy for 1/6 of the nation’s hospital patients.
I added facts at the end of the story where Dr. Rodriguez tried to explain how the hospital had benefited from the merger with the Catholic Health Association. But we have to ask the question, Does this matter? Should we weigh the pros and cons in this situation or should we have some absolutes and protect women’s reproductive choices, in particular following a rape. Does a doctor have a medical obligation to inform a patient about all options, even if he or she is not able to provide that service?
What’s your view on whether religious-affiliated hospitals should be able to limit the services offered to patients? Join the conversation on my Facebook page.