Commentary Religion

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

Imani Gandy

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: for how much longer are we going to permit religion to have a priority place in our political discourse over the health and safety of American women?

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.

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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.

News Human Rights

Lawsuit: Religious Groups Are Denying Abortion Care to Teen Refugees

Nicole Knight Shine

The suit accuses the federal government of paying millions to religious grantees that refuse to provide unaccompanied minors with legally required reproductive health services.

Two years ago, 17-year-old Rosa was raped as she fled north from her home country in Central America to the United States. Placed in a Catholic shelter in Florida, the teen learned she was pregnant, and told shelter officials that if she couldn’t end the pregnancy, she’d kill herself. She was hospitalized for suicidal thoughts. Upon her release, the facility in which she’d been originally placed rejected her because of her desire for an abortion, according to a federal lawsuit filed Friday. So did another. Both, reads the lawsuit, were federal contractors paid to care for unaccompanied minors like Rosa.

Rosa’s story is one in a series sketched out in a 16-page complaint brought by the American Civil Liberties Union (ACLU) against the U.S. Department of Health and Human Services (HHS). The suit accuses the federal government of paying millions to religious grantees—including nearly $20 million over two years to the U.S. Conference of Catholic Bishops (USCCB)—that refuse to provide unaccompanied minors with legally required reproductive health services, including contraception and abortion. The grantees are paid by the federal Office of Refugee Resettlement (ORR) to house and care for young refugees.

The lawsuit, brought in U.S. District Court in San Francisco, amounts to a fresh test of the degree to which Catholic organizations and other faith-based groups can claim exemptions from federal laws and regulations on religious grounds.

“Religious liberties do not include the ability to impose your beliefs on a vulnerable population and deny them legal health care,” said Jennifer Chou, attorney with the ACLU of Northern California, in a phone interview with Rewire. “The government is delegating responsibility … to these religiously affiliated organizations who are then not acting in the best interest of these young people.”

Mark Weber, a spokesperson for the HHS, which includes the ORR, told Rewire via email that the agency cannot comment on pending litigation.

Escaping turmoil and abuse in their home countries, young refugees—predominantly from Central America—are fleeing to the United States, with 33,726 arriving in 2015, down from 57,496 the year before. About one-third are girls. As many as eight in ten girls and women who cross the border are sexually assaulted; it is unknown how many arrive in need of abortion care.

The federal ORR places unaccompanied minors with organizations that are paid to offer temporary shelter and a range of services, including reproductive health care, while the youths’ applications for asylum are pending. But documents the ACLU obtained indicate that some groups are withholding that health care on religious grounds and rejecting youths who request abortion care.

The 1997 “Flores agreement” and ORR’s contracts with grantees, which the ACLU cites in its lawsuit, require referrals to “medical care providers who offer pregnant [unaccompanied immigrant minors] the opportunity to be provided information and counseling regarding prenatal care and delivery; infant care, foster care, or adoption; and pregnancy termination.”

In 2016, the federal government awarded 56 grants to 30 organizations to provide care to unaccompanied minors, including 11 that the ACLU claims impose religious restrictions on reproductive health care.

In one case, ORR officials struggled to find accommodations for 14-year-old Maria, who wanted to end her pregnancy, according to the complaint. An ORR official wrote, according to a document the ACLU obtained, that the agency would have liked to transfer Maria to Florida to be near family, but “both of the shelters in Florida are faith-based and will not take the child to have this procedure,” meaning an abortion.

In another, the complaint reads, 16-year-old Zoe was placed with Youth for Tomorrow, a faith-based shelter in Virginia, where she learned she was pregnant. She asked for abortion counseling, which was delayed nearly two weeks, the complaint says. Learning of her decision to end the pregnancy, Youth for Tomorrow asked to transfer Zoe elsewhere because of its abortion prohibition, even though Zoe said she was happy at the shelter.

For vulnerable youths, such transfers represent a form of “secondary trauma,” according to the ACLU’s Chou.

“These women have already endured so much,” she told Rewire. “The process of transferring these youths from shelter to shelter tears them away from their only existing support system in the U.S.”

Federal officials, according to the complaint, were aware that the religious grantees would withhold abortion referrals. In one case, the Archdiocese of Galveston-Houston was awarded more than $8 million between 2013 and 2016, although it stated in its grant application that rape survivors wouldn’t be offered abortion care, but instead permitted to “process the trauma of the rape while also exploring the decision of whether to keep the baby or plan an adoption.”

The lawsuit also claims that a contract with the U.S. Conference of Catholic Bishops included language requiring unaccompanied minors who were pregnant to be given information and counseling about pregnancy termination, but the ORR removed that language after the USCCB complained.

The USCCB did not respond to Rewire‘s request for comment. But in a letter last year to the ORR, the USCCB and five religious groups, including some ORR grantees, wrote they could not facilitate health-care services for unaccompanied minors that run contrary to their beliefs.

The lawsuit is the second the ACLU has filed recently against the federal government over religious privileges.

Last month, the ACLU filed a Freedom of Information Act suit demanding that the federal Centers for Medicare & Medicaid Services release complaints against federally funded Catholic hospitals, where patients have reported being denied emergency medical care in violation of federal law.

In 2009, the ACLU also sued the federal government for allowing USCCB to impose religious restrictions on a taxpayer-funded reproductive health program for trafficking survivors. In 2012, a district court ruled in the ACLU’s favor, and the government appealed. The First Circuit Court of Appeal later dismissed the case as “moot” because the government did not renew USCCB’s contract.

News Health Systems

Illinois Bill: Catholic Hospitals Must Inform Patients Where They Can Obtain Denied Care

Nicole Knight Shine

The legislation amends the state Health Care Right of Conscience Act to require religiously affiliated facilities to inform patients in writing about health-care providers "who they reasonably believe" offer procedures that the institutions will not perform.

Religiously affiliated hospitals in Illinois must advise patients where they can find treatments that the institutions won’t offer on religious grounds, under new legislation sitting on the governor’s desk.

The patient information measure, SB 1564, comes at a time when almost about 30 percent of hospital beds in the state—and one in six in the nation—are in Catholic institutions that bar certain reproductive health and end-of-life treatments, according to recent figures from the advocacy group MergerWatch.

The legislation amends the state Health Care Right of Conscience Act to require religiously affiliated facilities to inform patients in writing about health-care providers “who they reasonably believe” offer procedures that the institutions will not perform, or to refer or transfer patients to those alternate providers. Hospitals must do this in response to patient requests for such procedures. The legislation cleared the state house on a 61-54 vote and the senate on a 34-19 vote. Democrats control both chambers.

The office of Illinois Gov. Bruce Rauner (R) did not respond to request for comment on whether he would sign the bill.

Catholic facilities often follow U.S. Conference of Catholic Bishops religious directives  that generally bar treatments such as sterilization, in vitro fertilization, and abortion care. The federal Church Amendment and some state laws protect these faith-based objections.

Even so, growing concerns over facilities that deny treatment that patients want—and that doctors advise—has recently prompted lawmakers in Illinois, Michigan, and Washington state to advance patient information measures.

A Michigan lawsuit now on appeal alleges a Catholic facility caused unnecessary trauma by denying a patient treatment. In 2010, then-18-weeks pregnant Tamesha Means arrived at a Catholic hospital, Mercy Health Partners in Muskegon, Michigan, bleeding and miscarrying. On two occasions, the hospital turned away Means, as Rewire reported. It wasn’t until Means started delivering on her third hospital visit that she received treatment.

The Illinois legislation represents a compromise among the Illinois Catholic Health Association, the Illinois State Medical Society, and the Illinois affiliate of the American Civil Liberties Union (ACLU), representatives from the groups told Rewire.

Lorie Chaiten, director of the ACLU of Illinois’ Reproductive Rights Project, said in an online statement that the legislation “protects patients when health care providers exercise religious refusals.”

Research indicates that patients aren’t always aware that religiously affiliated facilities don’t provide a full spectrum of reproductive health services, according to a 2014 paper published in Contraception.

Patrick Cacchione, executive director of the Illinois Catholic Health Association, said the organization, which represents the state’s 43 Catholic hospitals, opposed an early version of the bill requiring religious health-care facilities to give patients a written list of known medical providers that perform the treatments that the religious institutions oppose.

Cacchione said such a direct referral would have made Catholic hospitals “complicit.”

“We will provide all the information you need, but we will not make a direct referral,” he told Rewire in a phone interview Monday. The new version of the legislation does not require hospitals to confirm that providers perform the treatments; the facilities must only have a “reasonable belief” that they do.

He said Illinois hospitals are already doing what the legislation now requires.

Approximately one in five doctors surveyed at religiously affiliated institutions “had experienced conflict with the institution over religiously based patient care policies,” according to the 2010 paper, “Religious Hospitals and Primary Care Physicians: Conflicts Over Policies for Patient Care,” published in the Journal of General Internal Medicine.

In an emailed statement, Dr. Thomas M. Anderson, a Chicago radiologist and president of the Illinois State Medical Society, told Rewire, “The Society strongly believes physicians should be able to exercise their right of conscience and changes made to SB 1564 protect that right.”