A woman births her fourth child at home, against the wishes of her doctor, after having had three prior c-sections and being told she'd need to have another; The ACLU urges the superintendent of the California school district where a young teen committed suicide from anti-gay bullying, to do something about it; and reproductive justice advocates in Minnesota fear they are in for a rough haul this upcoming legislative session.
A woman births her fourth child at home, against the wishes of her doctor, after having had three prior c-sections and being told she’d need to have another; The ACLU urges the superintendent of the California school district where a young teen committed suicide from anti-gay bullying, to do something about it; and reproductive justice advocates in Minnesota fear they are in for a rough haul this upcoming legislative session.
Women in Minnesota are in for some serious battling over their reproductive rights as the state legislature gears up for a new session in January. The President of the Minnesota Senate, Sen. Michele Fischbach is wife to Scott Fischbach – none other than the head of Minnesota Citizens Concerned for Life. Both houses are controlled by Republicans and, writes Andy Birkey at Minnesota Independent, while they have said their concerns lie more with jobs and the economy, reproductive justice advocates are gearing up for a rough session. What seems likely? Increased funding for abstinence only programs, “an outright ban on certain types of abortion procedures,” barring funding for any organizations which provide or refer for abortion just to name a few.
CNN asks: Is she a hero or a danger? Some say neither – that she’s “just a mom” as the Feminist Breeder writes. She’s a mom who, after being misled too many times and coming up against barriers put in place by a maternity care system embedded less in evidence and more in profit making and fear, decided to do what she believed was right and best for her – and her unborn baby. Aneka gave birth to her fourth child at home this month. She had been told by her Ob-Gyn, with her first, that her “hips were too small” and needed a c-section. With her next two it was the lack of providers who would peform VBACs. She finally decided she had a right not to have a c-section and found a midwife, at the last moment, who was willing to help.
The ACLU California affiliate, along with the mother of Seth Walsh, a 13 year old boy who committed suicide recently after being bullied repeatedly in school for being perceived as gay, has sent a letter to the school district superintendent “urging him to do more to prevent another tragedy.” The letter notes that school officials knew about the anti-gay harrassment against Walsh but largely ignored it. More here.
This is scary news: One in sixteen women hospitalized for childbirth has diabetes; either pre-existing or developed during pregnancy (called “gestational diabetes”). Diabetes carries risk of preterm birth as well as hypoglecemia and jaundice for the newborn. Read more here.
More on the Catholic Bishop, Thomas Olmstead, who is threatening to revoke a Catholic hospital’s status as formally a Catholic institution. Other religious voices have weighed in. From USA Today,
Lisa Fullam, professor of moral theology at the Jesuit School of Theology at Santa Clara University, blogged at commonwealmagazine.org that the hospital ought to stand up to the bishop.
“Why don’t they simply point out to Bishop Olmsted that, while under church law he can restrict who uses the appellation ‘Catholic,’ he does not have a copyright to the term under U.S. law? If the administrators at St. Joseph’s believe it to be a Catholic hospital, they should continue to use the name and let the canonical chips fall where they may. The bishop does not own Catholicism, in his diocese or elsewhere.”
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If we want Americans to understand and distance themselves from the moral emptiness of the “pro-life” movement, we will have to challenge the patriarchs on their home turf, in their position as moral guides.
Most Americans think of childbearing as a deeply personal or even sacred decision. So do most reproductive rights advocates. That is why we don’t think anybody’s boss or any institution should have a say in it. But for almost three decades, those of us who hold this view have failed to create a resonant conversation about why, sometimes, it is morally or spiritually imperative that a woman can stop a pregnancy that is underway.
My friend Patricia offers a single reason for her passionate defense of reproductive care that includes abortion: Every baby should have its toes kissed. If life is precious and helping our children to flourish is one of the most precious obligations we take on in life, then being able to stop an ill-conceived gestation is a sacred gift. Whether or not we are religious, deciding whether to keep or terminate a pregnancy is a process steeped in spiritual values: responsibility, stewardship, love, honesty, compassion, freedom, balance, discernment. But how often do we hear words like these coming from pro-choice advocates?
Our inability to talk in morally resonant terms about abortion has clouded the broader conversation about mindful childbearing. The cost in recent decades has been devastating. In developing countries, millions of real women and children have died because abortion-obsessed American Christians banned family planning conversations as a part of HIV prevention efforts. Those lost lives reveal the callous immorality of the anti-choice movement.
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Back home, here in the United States, our inability to claim the moral high ground about abortion has brought us one of the most regressive culture shifts of a generation. We are, incredibly, faced with “personhood rights” for fertilized eggs, pregnancies that begin legally before we even have sex, politicians with “Rape Tourette’s,” and a stunningly antagonistic debate about contraceptive technologies that could make as many as 90 percent of unintended pregnancies along with consequent suffering and abortions simply obsolete.
The voices that are strongest on reproductive rights often falter when it comes to the cultural dialogue. At least part of this absence is because so many of the pro-choice movement’s leaders and funders are secular and civic in their orientation, awkwardly uncomfortable with the moral and spiritual dimension of the conversation, or, for that matter, even with words like moral and spiritual. From language that seems moderately wise–Who decides?–we fall back on “safe, legal and rare” (a questionable effort to please everyone) or even the legal jargon of the “right to privacy.”
The other side talks about murdering teeny, weeny babies and then mind-melds images of ultrasounds and Gerber babies with faded photos of later abortions. And we come back by talking about privacy?? Is that like the right to commit murder in the privacy of your own home or doctor’s office? Even apart from the dubious moral equivalence, let’s be real: In the age of Facebook and Twitter, is there a female under 25 in who gives a rat’s patooey about privacy, let alone thinks of it as a core value?
The right to privacy may work in court. But it is a proxy for much deeper values at play. Privacy simply carves out space for individual men and women to wrestle with those values. In the court of public opinion, it is the underlying values that carry the conversation.
Far too often those who care most about the lives of women and children and the fabric of life on this planet limit themselves to legal and policy fights. Fifty years ago, reproductive rights activists took the abortion fight to the courts and won, and they have kept that focus ever since. But the legal fight has drawn energy away from the broader conversation. And the emphasis on “privacy” has meant that even the most powerful stories that best illustrate our sacred values are too often kept quiet.
Legal codes and cultural sensibilities are never independent of each other. Abortion rights were secured legally because of a culture shift that was aided by anguished stories and statements by compassion-driven Christian theologians during the 1960s and 1970s. The brutal deaths of American women every year, at a peak of thousands in the 1930s, was, beyond question or doubt, a profound immorality that many Americans were desperate to stop. Protestant leaders across the theological spectrum took a moral stand in support of legal abortion. In contrast to the Vatican, they had long agreed that thoughtful decision making about whether to bring a child into the world serves compassion and well-being—the very heart of humanity’s shared moral core.
At this point it should be clear that the tide has turned. Opponents, having lost in court, instead took their fight to conservative churches, where they have been refining their appeals for 40 years. The last few years have seen a systematic erosion of legal rights driven by a culture shift that had been building long before. It has also seen a complete reversal of the once-stalwart moral support for reproductive rights among American Protestants, which in the 1950s was seen as a moral good by almost every denomination from the most liberal to the most conservative. Unless this shift is challenged and stopped, there is every reason to fear that abortion will once again become inaccessible for most women in the United States.
Can pro-choice advocates reclaim the moral and spiritual high ground? Yes. But to do so will require a challenge to the status quo on two fronts. Rather than ignoring the right’s moral claims, we must confront their arguments. We must also express our pro-choice position in clear, resonant, moral, and spiritual terms. In other words, in combination, we must show why ours is the more moral, more spiritual position.
This isn’t as hard as it sounds. Most “pro-life” positions aren’t really “pro-life”; they are no-choice. They are designed to protect traditional gender roles and patriarchal institutions and, specifically, institutional religion. The Catholic bishops and the Southern Baptist Convention—both leaders in the charge against reproductive rights—represent traditions in which male “headship” and control of female fertility have long been tools of competition for money and power. They use moral language to advance goals that have little to do with the well-being of women or children or the sacred web of life that sustains us all.
The arguments they make to attain these ends are powerful emotionally but not rationally. They appeal to antiquated and brittle conceptions of God. They appeal to the crumbling illusion of biblical and ecclesiastical perfection—and the crumbling authority of authority itself. They corrupt the civil rights tradition and turn religious freedom on its head. They play games with our protective instinct and cheapen what it means to be a person. They lie.
That adds up to a lot of vulnerability in what should be the stronghold of the priesthood: their claim to speak for what is good and right.
Republican strategist Karl Rove will go down in history for his strategy of attacking enemies on their perceived strength—for example, by attacking John Kerry on his war record. In the recent election, we saw this strategy in play on both sides. Obama proved to be less vulnerable than his opponents hoped on his signature legislation, the Affordable Care Act. But by the time the election was over, Romney’s strongest credential, his background in business, was seen by many as parasitic “vulture capitalism.” If we want Americans to understand and distance themselves from the moral emptiness of the “pro-life” movement, we will have to challenge the patriarchs in their home turf, in their position as moral guides.
Here, for openers, are a few ways we might change the conversation:
1. Talk about the whole moral continuum. A moral continuum ranges from actions that are forbidden, to those that are allowed, to those that are obligatory. When it comes to abortion, we talk only about one-half of this continuum—Is it forbidden or is it allowed?—when, in actuality, a women faced with an ill-conceived pregnancy often experiences herself at the other end of the continuum, wrestling with a set of competing duties or obligations. What is my responsibility to my other children? To society? To my partner?To myself? (To cite a personal example, my husband and I chose an abortion under circumstances where it would have felt like a violation of our core values to do otherwise.) The current conversation doesn’t reflect the real quandaries women face, one in which moral imperatives can and do compete with other moral imperatives. Nor does it reflect the wide range of spiritual values and God concepts that enter into the decision-making process.
No-choice advocates say: Abortion is immoral. God hates abortion.
We can say:For me, bringing a child into the world under bad circumstances is immoral. It violates my moral and spiritual values. / Whose God decides?
2. Challenge the “personhood”/fetus-as-baby concept both philosophically and visually. The history of humanity’s evolving ethical consciousness has focused on the question of who counts as a person, and if the arc bends toward justice it is because it is an arc of inclusion. Non-land-owning men, slaves, women, poor workers, children—our ancestors have fought and won “personhood” rights for each of these, and abortion foes are smart to invoke this tradition. But their ploy involves a sleight of hand. The civil rights tradition is built on what a “person” can think and feel. By contrast, the anti-choice move is about DNA, and it seeks to trigger visual instincts that make us feel protective toward anything that looks remotely like a baby, even a stuffed animal. In reality, the tissue removed during most abortions is minute, a gestational sac the size of a dime or quarter, which is surprising to people who have been exposed to anti-abortion propaganda. It strikes almost no one as being the substance of “personhood.”
They say: Abortion is murder. Abortion kills little babies.
We can say: A person can think and feel. My cat can feel hungry or hurt or curious or content; an embryo cannot. / Thanks to better and better pregnancy tests, over 60 percent of abortions now occur before 9 weeks’ gestation. Want to see what they actually look like?
3. Admit that the qualities of “personhood” begin to emerge during gestation. Pregnancy is no longer the black box it was at the time of Roe v. Wade. Ultrasound and photography have made fetal development visible, and research is beginning to offer a glimpse into the developing nervous system, with the potential to answer an important question: What, if anything, is a fetus capable of experiencing at different stages of development? Although this isn’t the only question in the ethics of abortion, it is undeniably relevant. How we treat other living beings has long been guided by our knowledge of what they can experience and want. By implication, ethics change over the course of pregnancy. A fertilized egg may not be a person except by religious definitions, but by broad human agreement a healthy newborn is, and in between is a continuum of becoming. Most Americans understand this argument morally and emotionally. The Roe trimester framework also codified it legally. Ethical credibility requires that we acknowledge and address the ethical complexities at stake.
They say: A fetus is a baby. A baby is a living soul from the moment of conception.
We can say: In nature, most fertilized eggs never become babies. A fetus isbecoming a baby, grows into a baby, is a potential person, or is becoming a person.
4. Pin blame for high abortion rates where it belongs—on those who oppose contraception—and call out the immorality of their position because it causes expense and suffering. Unintended pregnancy is the main cause of abortion. Right now half of pregnancies in the United States are unintended. For unmarried women under 30, that’s almost 70 percent. A third of those pregnancies end in abortion. The reality is that abortion is an expensive, invasive medical procedure. For the price of one abortion, we can provide a woman with the best contraceptive protection available, something that will be over 99 percent effective for up to 12 years. If every woman had information and access to state-of-the-art long-acting contraceptives, half of abortions could go away before Barack Obama gets out of office.
They say: Liberals are to blame for abortion. Planned Parenthood is an abortion mill.
We can say: Obstructing contraceptive knowledge and access causes abortion and unwanted babies. That’s what’s immoral. We have the technology to prevent almost all of the suffering and expense caused by unintended pregnancy, but many women don’t have access to that information or technology because of the twisted moral priorities of religious and cultural conservatives. Barack Obama and Planned Parenthood have done more to prevent abortions in America than all of the choice opponents combined. The no-choice position is anti-life. It kills women. It puts faith over life.
5. Acknowledge and address the powerful mixed feelings surrounding abortion. The most common emotional reaction to abortion is relief. That said, women react physically and emotionally in a variety of ways to terminating a pregnancy. Sometimes, even those who are clear that they have made the best decision feel a surprising intensity of loss. Women should be given the support they need to process whatever their experience may be. We also need to understand that some abortion opponents actively induce guilt and trauma in women who have had abortions.
They say:Abortion is psychologically scarring. Women end up haunted by guilt and permanently traumatized after having an abortion.
We can say:No one should do something that violates her own values. Violating your values is wounding; that is why each woman should be supported in following her own moral, spiritual, and life values when making decisions about pregnancy.
6. Own religious freedom. Religious freedom is for individuals, not institutions. If the women and men who work for religious institutions all perceived the will of God in the same way, their employers wouldn’t be trying to control them by controlling their benefits package. Religious institutions have always tried to override the spiritual freedom of individuals, and they use the arm of the law as a lever whenever they can, and that is what they are doing now.
They say: Employers shouldn’t be forced to provide contraceptive or abortion coverage.
We can say: The freedom to choose how your employees spend their hard-earned benefits and the freedom to choose whether to have a child are two very different things. No institution—and nobody’s boss–should have a say in one of the most personal and sacred decisions we can make: whether to have child. That is why all women, regardless of who they work for, should have access to the full range of contraceptives and reproductive care.
7. Talk about children and parenting, not just women. Responsible and loving parents do what they can to give their kids a good life. We take our kids to doctors, get them the best schooling we can afford, love them up, and pour years of our lives into helping them acquire the skills that will let them be happy, kind, generous, hard-working adults. But parenting starts before we even try to get pregnant. We consider our own education and finances and whether we have the kind of partnership or social support that would help a child to thrive. We may quit smoking or drinking to be as healthy as possible during pregnancy.More often than not, the decision to stop a given pregnancy is a part of this much bigger process of mindful, responsible parenting.
They say: Abortion is selfish. Women just want to have sex without consequences.
We can say: A loving mother makes hard decisions to bring her kids the best life possible. A responsible woman takes care of herself. A caring father wants the best life possible for his children. Wise parents know their limits.
8. Embrace abortion as a sacred gift or blessing. For years we have talked as if abortion were a lesser evil, rather than a remarkable gift. In reality, no medical procedure is pleasant and yet the option to have the treatments and surgeries we need is an unmitigated good. The term “safe, legal and rare” confuses things because it implies that what should be rare is the treatment rather than the problem, unintended pregnancy. An abortion should be exactly as safe, legal and rare as a surgery to remove swollen tonsils or an infected appendix. If we think about abortion like we think about other medical services, then the attitude is one not of shame or ambivalence but of gratitude.
They say: Abortion is bad. An abortion is regrettable.
We can say: An ill-conceived pregnancy is bad. An unintended pregnancy is regrettable. An abortion when needed is a blessing. It is a gift, a grace, a mercy, a cause for gratitude, a new lease on life. Being able to choose when and whether to bring a child into the world enables us and our children to flourish.
9. Honor doctors who provide abortion services as we honor other healers. The human body fends off most infections and cancers, but not all. It spontaneously heals most broken bones and closes many wounds but not all. Similarly, it spontaneously aborts most problem pregnancies, but not all. Nature tends to abort pregnancies where there are problems with cell division or fetal development, where there is little chance for a fetus to become a healthy, thriving person. Through medical or surgical abortion, as through every other medical procedure, doctors and healers extend the work of nature—of God, if you will—to promote health and well-being. By ending pregnancies that don’t have a good chance to turn into thriving children and adults, they are—literally or metaphorically–doing God’s work.
They say: Abortionists are murderers.
We can say: God (or Nature) aborts most fertilized eggs. Abortion doctors are compassionate healers who devote their lives to helping women and men ensure that they have strong, well-planned, wanted families. Their work is as sacred as any in the field of medicine.
10. Honor women who decide to terminate pregnancies just as we honor motherhood. Sometimes the decision to end a problem pregnancy is clear and simple. Other times not. Either way, a woman often has to fight off a sense of shame and blame that she has internalized from religious and social conservatives—too often, including other women. She may feel bad even when her own values are clear and the decision has been thoughtful. How often do we affirm and honor the wisdom of women who make difficult childbearing choices (abortion, adoption, waiting) so as to best manage their lives and their parenting?
Most women choose an abortion so that they can later choose a well-timed pregnancy; or so they can take good care of the kids they have, ensuring those kids have the best possible chance in life. Sometimes a woman ends a pregnancy because she is choosing to put her life energy elsewhere. Even then, she is accepting that to embrace life fully she must choose among the kinds of good available to her and take responsibility for avoiding harm. She may or may not put it in these terms, but those are moral and spiritual questions, the kind that religion has long sought to guide. That is why many religious traditions support a woman or couple in weighing their own deepest values when it comes to reproductive decisions.
As individual stories show, the decision to end a pregnancy may be based in humility, responsibility, nurturing, prudence, forethought, vision, aspiration, stewardship, love, courage … or some combination of these qualities. Mere tolerance fails to affirm the many strengths that go into reproductive decisions, including the decision to end a pregnancy. These are virtues worthy of honor.
They say: An abortion is shameful. An abortion should be kept secret. An abortion needs to be forgiven by God.
We can say: Choosing abortion can be wise and brave. It can be loving and generous. It can be responsible and self-sacrificing.
The bishops are engaging in a public relations campaign that is more myth than fact. Here are several claims you can expect to hear from the bishops—followed by the truth about what health care under the "Ethical and Religious Directives" means for people who need care at a Catholic hospital.
On Monday, the American Civil Liberties Union (ACLU) and the ACLU of Michigan announced they had filed a lawsuit against the United States Conference of Catholic Bishops (USCCB) “on behalf of a pregnant woman who miscarried and was denied appropriate medical treatment because the only hospital in her county is required to abide by religious directives.” Written by the USCCB, the directives “prohibited that hospital from complying with the applicable standard of care in this case.”
The ACLU is taking the USCCB to task for requiring that all Catholic health-care facilities abide by the “Ethical and Religious Directives for Catholic Health Care Services,” which prevent Catholic hospitals from, among other things, offering an abortion under any circumstances, even when a fetus has little to no chance of survival and the woman’s life or health are at risk.
A recent Catholics for Choice/ACLU poll found that when it comes to abortion, nearly all respondents say doctors should not be allowed to withhold information about a fetus’ health for fear the woman may have an abortion, and majorities say doctors should not be allowed to refuse to make a referral for an abortion and that Catholic hospitals should not be allowed to refuse to provide medically necessary abortions. Nonetheless, we know that at least in the case of Tamesha Means, the woman the ACLU is representing, this made little difference.
Unfortunately, we also know that in Catholic hospitals in Michigan and across the country medical decisions are often derailed by the bishops’ directives.
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Catholic health care is big business, especially in Michigan, where Catholic health care is health care for many people. Of all hospital admissions that occur in the state, between 20 and 29 percent occur in a Catholic-run facility. In total, Michigan’s 23 Catholic hospitals care for 5,142,006 patients each year. The state’s eight Catholic health-care centers attend to 517,084 patients annually. Not all of the individuals treated by the Catholic health system are Catholic, but there are 2,008,445 Catholics in Michigan—21 percent of the state’s population. Only 17 of them are bishops. Mercy Health Partners, the hospital where the above case took place is the only one in the county.
It is worth noting that a significant percentage of the health care delivered in the United States comes from the country’s 630 Catholic hospitals, which make up 12.6 percent of the nation’s total. People in certain areas may rely upon Catholic health care because there are few other options—nearly one-third (32 percent) of all Catholic hospitals are located in rural areas. The economically vulnerable individuals served by Medicaid are often treated at Catholic hospitals, which account for 13.7 percent of all Medicaid discharges in the United States (nearly one million patients, at 978,842).
In addition, there are 56 Catholic health systems, which are enormous conglomerations made up of many separate Catholic-run hospitals. Catholic hospital systems are among the largest in the country—among the top five biggest nonprofit systems, four (80 percent) are Catholic, and all of the top three are Catholic. These three largest entities alone comprise 268 hospitals. Looking at the nation’s ten largest nonprofit health systems, six of the ten (60 percent) are Catholic. Of the group of the 25 largest nonprofit health-care systems, 11 (44 percent) are Catholic-run. When one considers the 868 hospitals affiliated with the top 25 largest hospital systems in the country, 493 of these are Catholic. All of those operate under the bishops’ directives.
Under the directives, the reality for women who find themselves at a Catholic hospital means they have:
No access to abortion—even in cases of rape or incest (Directive 45)
No access to in-vitro fertilization (Directives 37, 38, 39)
No access to contraception (Directive 52)
No treatment for ectopic pregnancy (Directive 48)
None of the benefits of embryonic stem-cell research (Directive 51)
No respect for their advance medical directives (Directive 24)
The sole exception to the ban on contraception falls under Directive 36, which only allows the provision of emergency contraception (EC) in cases of sexual assault when it can be proven that pregnancy has not occurred. This creates an unnecessary restriction, as EC does not interfere with the implantation of a fertilized egg. Evidence also suggests that many Catholic hospitals rarely provide EC even under the circumstances approved by the directives. A 2006 study found that 35 percent of Catholic hospitals did not provide EC under any circumstances, while 47 percent refused to provide referrals to hospitals that did. Of those that provided referrals, only 47 percent of these led to a hospital that actually provided EC.
The Misinformation Campaign
The bishops who claim that Catholic institutions care for the poor and underserved in a fashion that surpasses other nonprofit hospitals are engaging in a public relations campaign that is more myth than fact. Here are several claims you can expect to hear from the bishops—followed by the truth about what health care under the Ethical and Religious Directives means for people who need care at a Catholic hospital.
Claim: Catholics support the directives and do not want or expect their hospitals to provide services that are forbidden. “With the support of the faith community, Catholic organizations and agencies provide pastoral services and care for pregnant women, especially those who are vulnerable to abortion and who would otherwise find it difficult or impossible to obtain high-quality medical care.” – USCCB, “Pastoral Plan for Pro-Life Activities: A Campaign in Support of Life,” 2011.
In Fact: Many Catholics do not even know about the directives and are shocked when they find out that Catholic hospitals do not provide a full range of medical services. Catholics throughout the United States rely upon their individual consciences when making decisions about which reproductive health-care services they use and want their hospitals to provide. In 2009, more than six in ten Catholic voters (62 percent) indicated that hospitals and clinics that take taxpayer dollars should not be allowed to refuse to provide medical procedures or medications based on religious beliefs, and most Catholic voters (78 percent) oppose allowing pharmacists to refuse to fill prescriptions for birth control.
Catholics use and obtain contraception and abortion at rates similar to the rest of the U.S. population and support access to these services. Sexually active Catholic women above the age of 18 are just as likely (98 percent) to have used some form of contraception banned by the hierarchy as women in the general population (99 percent), and less than 2 percent of sexually active Catholic women use the bishops’ preferred method (natural family planning) as their primary form of birth control. In 2008, a study of almost 9,500 women showed that Catholic women have abortions at the same rate as other women: 28 percent of women who had an abortion self-identified as Catholic, while 27 percent of all women of reproductive age identified as such. The facts tell the story—the majority of Catholics have rejected the USCCB’s hard-line stance, as outlined in the directives, and instead support access to comprehensive reproductive health care and need their hospitals to provide these services.
Claim: “Catholic health care does not offend the rights of individual conscience by refusing to provide or permit medical procedures that are judged morally wrong by the teaching authority of the Church.” – USCCB, The Ethical and Religious Directives for Health Services, 2011.
In Fact: The reverse is true. Catholics throughout the United States rely on their consciences to use services that are banned under the directives. Last year, Catholic hospitals employed over 600,000 full-time staff, accounting for 16.7 percent of all full-time hospital staff in the United States. Time and time again, medical professionals employed by Catholic hospitals have reported that, out of fear of theopolitical retribution or out of sincere adherence to the draconian measures imposed by directives, their institutions have forced them to endanger women’s lives by denying timely and necessary reproductive health care. Catholic medical professionals have described situations in which, due to these strictures, they have provided substandard care to women seeking treatment for miscarriage or ectopic pregnancy.
While it serves neither the patient seeking care nor the dictates of conscience to force individual medical professionals to provide services they consider immoral, it goes too far to grant such blanket rights to an institution. Catholicism requires deference to the conscience of others in making one’s own decisions. Its intellectual tradition emphasizes that conscience can be guided but not forced in any direction. The directives, in their rigidity and their enforcement by the bishops, dictate to people what services they may provide and access rather than respecting the individual capacities of women and their doctors to form their own decisions.
When a young pregnant woman with pulmonary hypertension finds her life in danger and decides that it is best to defend herself by discontinuing her pregnancy, as happened in the case of St. Joseph’s, the hospital where she is treated has an ethical obligation to respect her decision. When an unemployed mother of five decides that she cannot have more children and seeks a tubal ligation, she should not have to worry about whether her right to follow her conscience will be denied. When a doctor has made the choice to save a woman on her operating table rather than waiting to perform unnecessary tests and waste precious minutes, that provider should have the ability to provide rapid, life-saving care without fear of retribution from administrators or the local bishop.
In addition, Catholic hospitals in the United States are part of a pluralistic society and have a moral obligation to respect the religious beliefs and denominations of all those whom they treat and employ, and whose taxpayer dollars they utilize, including many non-Catholics. Ultimately, when the bishops stop writing prescriptions for both individuals’ consciences and their medical care, all of us will benefit.
Claim: “Whether young or old, rich or poor, insured or uninsured, people in the US find the care they need—care always respectful of their dignity as human persons—at Catholic-sponsored health care facilities … [Catholic hospitals are] a passionate voice for compassionate care.” –Sr. Carol Keehan, CHA President and CEO, “Catholic Health Association Brochure,” 2010.
In Fact: Catholic hospitals routinely deny basic reproductive health-care services, leaving women without the respectful care that the CHA claims to provide. The Catholic health-care system indeed provides some important services in communities across the United States. The reality is, however, that the CHA and USCCB aim to highlight their commitment to human dignity and the poor while simultaneously refusing to meet the health needs of the people they serve.
By banning most services for women experiencing miscarriages, seeking to avoid pregnancy, or in need of abortion care, and turning away couples attempting to conceive a child through new reproductive technologies, Catholic hospitals in fact demonstrate a lack of compassionate understanding of peoples’ lives.
Even in instances in which the directives allow some reproductive health-care services, such as the emergency contraception provision for rape survivors included in Directive 36, many Catholic hospitals still refuse to comply with basic standards of medical care. In a 1999 survey of 589 Catholic hospitals, 82 percent stated that they did not provide EC under any circumstances. In a 2002 study, 328 of the 597 Catholic hospital emergency rooms surveyed refused to dispense EC under any circumstances.[xii] In 2006, only 37 percent of Catholic hospitals surveyed stated that EC was available for sexual assault patients at their hospital, while 35 percent stated that EC was not available under any circumstances. For the sexual assault survivor who turns to a Catholic emergency room during her time of crisis and is denied emergency contraception, the CHA’s dedication to “compassionate care” may ring false. In addition, a recent study examined the impact that the directives have on the care pregnant women receive at Catholic hospitals and concluded that women presenting with symptoms related to ectopic pregnancies were denied information about, and access to, possible treatments.
Claim: “[Catholic hospitals] operate not out of a profit motive but out of charity. In 1998, for example, the nation’s 637 Catholic hospitals’ service to the poor resulted in a $2.8 billion financial loss.” –Maureen Kramlich, US Conference of Catholic Bishops’ Secretariat for Pro-Life Activities, “The Assault on Catholic Health Care,” 2002.
In Fact: Catholic hospitals operate under the same tax laws as other nonprofit hospitals, charge market rates for health care services, receive the same government funding as non-Catholic hospitals and do not provide any more charity than other health care systems. In 2002, a MergerWatch study found that public hospitals provided twice as much free care as Catholic hospitals, based on charity write-offs.
Furthermore, directly following the “merger mania” of the mid-1990’s, some Catholic health systems actually saw double-digit revenue surges compared to previous years. In 2004, Ascension Health, the largest Catholic system and sixth-largest health-care system overall based on its number of acute-care hospitals in 2003, achieved a $10.04 billion, or 11 percent, revenue growth in the fiscal year ending in 2004.
U.S. tax dollars continue to fund Catholic hospitals, which do not provide the full range of health services. A 2002 study of over 600 religiously affiliated hospitals found that they received more than $45 billion in public funds. Approximately half of this revenue was received from Medicare, Medicaid and other government programs.
As a 501(c)(3) nonprofit organization, the CHA itself also benefits from tax breaks similar to those provided to charitable, religious, educational, literary, scientific, public safety, amateur sports, children’s and animal rights organizations such as the American Cancer Society, the Poetry Foundation and American Society for the Prevention of Cruelty to Animals. By the conclusion of the fiscal year ending on June 30, 2010, CHA had garnered over $26 million in assets.
Tax breaks and government funding to organizations that do not provide the full range of reproductive health do not bode well for the health of U.S. Catholic and non-Catholic taxpayers. During the 2009 health-care reform debate, the majority of Catholic voters (65 percent) indicated that hospitals and clinics that receive taxpayer dollars should not be allowed to refuse to provide medical procedures or medications based on religious beliefs. A majority of Catholic voters (60 percent) also believe that hospitals and clinics that take taxpayer dollars should be required to include condoms as part of HIV prevention.[xx]Women, meanwhile, disapprove of circumstances in which a Catholic hospital would become the only medical institution in their community (68 percent), while 85 percent reject the idea that Catholic hospitals receiving government money should be allowed to ban procedures because of religious beliefs.
Claim: Patients can go to another hospital if they need procedures that Catholic hospitals do not provide. “Those who have decided to be critical of Catholic healthcare apparently work hard to find some of those few cases in which one or more elective procedure [sic] may have been eliminated within a community. But we fail to see how they can jump to the conclusion that women have ‘no access’ to the elective procedures.” –Rev. Michael D. Place letter to Redbook Editor in Chief Lesley Jane Seymour, 2000.
In Fact: More than one third (32 percent) of U.S. Catholic hospitals are located in rural areas, and they are often the only local health-care providers in these communities. For the men and women who depend on these hospitals, however, their right to even basic reproductive health services is severely compromised. If the hospital is Catholic and will not fulfill the needs of the community it serves, then the hospital is frankly not helping people who have no other choice in health care.
In areas where Catholic hospitals are often the only health-care providers, those without the means or, in the case of emergency situations, the time to travel cannot access alternative care. In the span of one year, Catholic hospitals accounted for more than 2 million Medicare discharges (16.7 percent of the national total) and more than 900,000 Medicaid discharges. These patients, some of them the poorest of the poor, were left without access to their basic health-care needs. For example, a Medicaid patient in eastern New Orleans arriving at a hospital in the Franciscan Missionaries of Our Lady Health System and hoping to prevent an unplanned pregnancy with modern contraception will not get the care she needs. A woman in rural Nebraska who cannot take time off from work to travel many miles to a non-Catholic hospital after a potentially life-threatening diagnosis of ectopic pregnancy will also find that most treatment options are closed to her.
Even those individuals whose financial status or location may normally enable them to travel to a non-Catholic facility can find themselves reliant upon Catholic hospitals. More than 19 million emergency room visits occurred in Catholic facilities during 2009. Women experiencing medical duress due to ectopic pregnancies, miscarriages or rape may not have the time or the luxury of choosing another hospital. A woman in this situation will not have her medical wishes honored, but may instead find herself in a hospital that will allow her condition to dangerously deteriorate out of a strict adherence to the directives.
Many people are also not aware of the restrictions imposed by the directives until they are in need of the services that are banned. Often, patients believe the name of the hospital to be a name only and are unaware that it indicates a different standard of health care. Even non-Catholics who seek care at a Catholic institution are subject to the directives, and many will be surprised to learn that the care they require is unavailable.
Catholic hospitals are, first and foremost, health-care facilities—they all receive taxpayer money and they must adhere to standards of health care. This means providing comprehensive care for all patients. The USCCB and CHA aim to highlight the importance and commitment of Catholic services to the community, while at the same time downplaying the reproductive health needs of the people they serve and whose tax dollars they continue to utilize. A health-care institution should primarily provide care with a focus on its responsibility to the patients, employees and community it serves.
Catholics and non-Catholics recognize this and consistently exercise their own judgment when making decisions about which reproductive health services they want to use and want their hospitals to provide.
Catholics for Choice remains convinced of the moral capacity of men and women to make their own decisions regarding their reproductive lives. We are committed to the idea that access to reproductive health care is a matter of social justice, and that all people, Catholic or not, should be able to walk into a hospital without fear that their medical needs will not be met.
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