What is the Role for Catholic Healthcare?
I think, however, there is a tangential and deeper issue. What is the role of Catholic hospitals in a pluralistic society? That’s going to affect the lens through which one views the health care reform proposal. Some people–such as the philosopher Germain Grisez — think they should consider going out of the acute care business entirely rather than accept the inevitable material cooperate with evil that goes along with participating in a broadly secular health care system. He doesn’t really see the point in Catholic health care at the acute level. I myself think his approach is the wrong approach on two counts. First, I think Catholic health care still provides an important witness that acute health care is not simply a service like any other, but always is also a work of mercy. Second, I also think that ability to bring about real change depends upon having an ongoing stake in the system. You can only quit once.
But I do wonder: How prevalent is Grisez’s attitude in the Church, and at the bishops’ conference in particular? I also wonder: What do Peter Nixon and Unigidon think, since they’re in the industry? What is the role of Catholic health care in a post-health-care reform society?
Here is a horrendous story of symphyiotomy surgery carried out on Irish women from 1944 to 1984 by doctors more Catholic than the Pope. The political and medical establishments are stonewalling, but this is another abuse scandal waiting to unfold. http://vimeo.com/7930110
Good lord–I’ve never heard of that. How horrible.
Note that this video was presented by the Feminist Open Forum.
This means that it is automatically suspect, anti-Catholic and worthy of righteous rosary praying by the Catholic wingnuts.
It seems that there might be conflicts ….. doctors working at Catholic hospitals who may or may not be Catholic and whose main loyalty might be to the patient and to what they see as excellence in medicine rather than to Catholic teaching, and patients who may not be Catholic but who end up at Catholic hospitals – they may disagree with Catholic teaching, for example, have living wills directing under what conditions they be kept alive (Directive #58). Given that non-Catholics often have no choice about going to a Catholic hospital, and that non-Catholic doctors may work there, I think it’s unrealistic and maybe unfair to use Catholic teaching as a medical template.
A true horror, just when I thought it not possible for Catholic influences to find additional expressions of cruelty to women. The contortions of popes and bishops when it comes to distortions of human sexuality are limitless. Women were not to be consulted about their own care, just abused for the so-called purity of Catholic doctrine.
It will be interesting to hear the episcopal spin on this one: exonerating in every sense, I bet.
Just in case, I insist on not going to a Catholic hospital, as did my wise mother, Lord rest her soul.
Carolyn–
Why do you insist on not going to a Catholic hospital?
In a nutshell, I do not trust any bishop(s) to make health care decisions for me. Nor do I want my doctors bound by their directives. Given my opinion of their moral authority, I find likely episcopal definitions of what is best for my welfare highly suspect.
Back to the question at hand, I think Grisez raises an interesting point: The element of Catholic witness seems key, but I think that we should ask what makes Catholic acute care different from “secular” acute care? Catholic universities can clearly be Catholic and help to form people in a certain way. Acute care seems to be acute care (these days, and in the U.S.).
Carolyn–
So, I assume you are not Catholic then?
Going to a Catholic hospital is the Right’s new standard for determining who is a Catholic?!
Nice…
David–
Please, control the snark, and try to read posts more carefully. I am simply trying to fully understand the context of Carolyn’s post. If someone does not trust the moral authority of ANYONE in whom the Catholic Church has invested its teaching authority, it is not unreasonable to conclude that that person is not a Catholic. Let’s try to advance the debate, and not read the worst of intentions into the post of someone who has a different opinion than yours.
I intended to leave the question unanswered as not germane to the thread, and respond offline. I suspect most here who have patiently endured some tiresome posts know I am Catholic, at least by my definition as a regular communicant, slouching at least toward Bethlehem, Lord willing.
Mark, by way of explanation, seven years as an advocate for clergy abuse survivors with ample documentary evidence of bishops’ corruption, has left me very cynical and jaded. The rose-colored glasses are gone, and I do not trust them to speak truthfully. They are an impediment to my faith. We shall most likely not convince each other differently, but I accept our views are opposed, though hopefully in respectful fashion. (I admit struggling sometimes not to cross a line, when frustration takes over.)
Back to the thread, though. Catholic hospitals have a right to adhere to principles of the Catholic faith, but the issues are more complicated than a catechism answer. I think taking your marbles and going home is shortsighted though; better to remain part of the conversation. I personally just do not want to get caught in the crossfire somehow.
I think all hospitals are dangerous; a friend was brutalized by a sadistic doctor during childbirth and went to the local well women center to recover — it was run by the same doctor’s wife…
As a Catholic I would be afraid to end up in a Catholic hospital given Vatican attitudes to end of life care — perhaps they would keep me alive in some degrading or extremely painful state instead of allowing me to die with dignity…
Joseph, given that Roman Catholicism has some of the most permissive moral requirements for removing or refusing life-sustaining treatment (and for using pain medication which speeds death), I wonder why you have this worry?
I suppose the main problem would be ANH–tube feeding. Now, whatever the ERDs say, it’s pretty clear under American law that there’s no right for a hospital to keep you or do anything to you against your will–or against the will of a health care proxy, if you’re not competent. So, if a hospital (any hospital) wants to continue treatment –of any sort, and you don’t want to, they’d have to have a transfer protocol in place.
And even that’s probably more of a problem in nursing homes, than acute care facilities.
Carolyn—
Thanks for the respectful and thoughtful reply, I hope you did not think I was being intrusive. Here’s why I think your religious affiliation is germane. If a non-Catholic says she’d never go to a Catholic hospital, that’s not all that big a deal. If a Catholic says she’d never go to a Catholic hospital (and presumably you’re not the only one who feels that way), then Catholic hospitals may have a real problem on their hands.
Although I agree that there are probably many things we disagree on, we do agree on a few. I, too, have been disappointed with the U.S. episcopacy, as a whole, for many years now. They seem to have been a timid lot, willingly susceptible to group-think. A risk-averse bishop is the devil’s workshop (or something like that). I see signs of that changing, though, so I’m hopeful.
I also agree that it would be wrong for Catholic hospitals to leave the arena. But if they stay, they need to realize they have a fight on their hands with the Zeitgeist when it comes to end of life issues, so I hope they have the stuff to engage. I think the bishops can help them understand the importance of this fight.
Sometimes the problem is not the Catholic hospital but the self-described “Catholic” doctor. When my mother was dying it was the family doctor who wanted to load her down with tubes, etc. To prolong her life, even though he admitted that she had told him she didn’t want that done.
After consulting with the Monsignor who taught the morality of end of life care at the local seminar, we went against the doctor’s advice. He severaltimes accused me of believing in euthanasia. But my father held fast. After my mother died I demanded an apology from the otherwise fine MD, but got none, so my family switched to another family doctor.
Follow your conscience, folks. Don’t put up with nonsense. It isn’t a kindness.
Ann:
That doctor’s actions sound prompted by defensive medicine (aka defensive against liability) more than Catholic teaching. For it is *not* Catholic teaching to “load her down with tubes” to “prolong life” (or the dying process) at the end of life.
Do you think JPII was “loaded down with tubes” at the end of his life? Medically, he could have been, but he wasn’t, of course.
Good call about American public policy, Cathy…but even with regard to the Church’s position about ANH in a PVS the newly worded directives just seem to codify what the CDF already said: that ANH is ‘in principle’ an ordinary means of treatment. The CDF enumerated several examples where it could, in fact, be extraordinary treatment. And given that the Church almost always lets a competent person or their surrogate make the benefit/burden call themselves, I still don’t understand Joseph’s concern.
I understand it . . . I was a health care lawyer for three years in Boston and I know that if the hospital and the doctors disagree with a treatment decision, they can bring a lot of pressure to bear. Fortunately, the hospitals I worked with were very committed to putting in policies that respected patient rights-not merely at the top of the decisionmaking process, but all throughout.
Furthermore, if family members disagree about treatment, hospitals can get caught in the middle–and this can happen even if there is a durable power of attorney or or a clear line of decision-making power. This is one overlooked lesson from the Schiavo case. And many people do not understand the traditional distinctions well–even Catholics.
Jennifer –
The doctor in question was not just our doctor, he was an old friend from college days. He wasn’t practicing defensive medicine, he was trying to impose his version of Catholic medical ethics. In this city there are many super-conservative Catholics who agree with him that that is the teaching of “the real Church”. Granted, he too must follow his conscience. But, of course, that doesn’t make him right about “what the Church teaches”.
This is another case which illustrates a serious lack of a theological epistemology — that is, a lack of principles for discovering just what the settled teachings of the Church are.
Ann,
Same thing with my mother 30 years ago, but since she was not in a Catholic hospital, I as an only child had no hassle. It was a terribly vulnerable time, and to add static from some prelate or his surrogate, would have been beyond painful. Without going into detail, I had surgery myself 20 years ago at a Catholic hospital, unknowingly ran into their rules, and was powerless.
You never know what can happen if some Catholic hospital or bishop or doctor decides they know better than my hopefully prayerful conscience in some way I cannot foresee.
I have a bit of self-protective grim humor written on my consent forms: “When in doubt, take it out; to really win, don’t put it in.” You could be in for a real nightmare otherwise. “Do not resuscitate” orders are another potential hazard in a Catholic hospital.
I find it compelling that JO’Leary, as a priest, shares my concern.
Great post.
It strikes me that from a Church perspective, balancing service and adherence to the Gospel becomes more difficult than ever in a time in which our politics and faith become more intertwined.
Part of the problem is that it’s clear that, while the role of religious leaders to speak out in the public square should not be in question, the mantra of the Truth” often exercised on the Catholic right may throw the balance out of whack.
The problem can be with doctors, hospitals or health care systems.
I’ve watched from a distance how St.Vincent’s Hospital in Santa Fe has come unde r the aegis of Christus Health care and how the State has several times now sought and received assurances that the takeover will not change the delivery of (women’s reproductive among others) services.
The issue also extends to charitable services, I would think, as the recent Washingtron DC Catholic Charities flap made clear.
To what extent do we need to be first concerned about magisterial proclamation over service in a society such as ours?
I think one relevant question is how our service providers are effective in proclaiming their values to all and not just inside the Church, for that is a very special and I think provocative evangelizing.And, especially so, when the service delivery touches basic issues of the lives of people.
Bob –
It seems to me progressives need to be just as careful about not trying to impose our own principles on other people. Since the nuns who administer Catholic hospitals are giving their lives freely, it seems to me those who take advantage of their services have no right to *demand* what those services shall be.
On the other hand, here in New Orleans Charity Hospital, run since the 1700s by the Sisters of Charity, had become a State hospital. the nuns no longer owned it. When the Courts decided that the hospital must provide abortions, the nuns quit as admnustrators, a great loss to the community. But I don’t see what either side could have done differently legally.
On the third andy, the Charity nuns are now building their own clinic in a poor neighborhood. I don’t see why they should not be allowed to offer only certain proceedures while being given State monies for those particular services? Anslogously, if the State contracts with a builder to build only certain knds of buildings there is no obligation on the building contractor’s part to build additional sorts of buildings at the request of the State.
The US Conference of Catholic Bishops released an “Ethical and Religious Directive” this month that would ban any Catholic hospital, nursing home or hospice program from removing feeding tubes or ending palliative procedures of any kind, even when the individual has an advance directive to guide their end-of-life care. The Bishops’ directive even notes that patient suffering is redemptive and brings the individual closer to Christ …. – Catholic Bishops Enact Plan For “300,000 Terri Schiavos”, November 24, 2009
A few minutes ago, when I came upon a quote from Erasmus, I was reminded of the exchanges earlier on this thread. The quote: “Thus I put up with this Church, until I see a better one; and she is forced to put up with me, until I myself become better.”
This topic reminds me of a blog post I wrote back on December 17th 2008. It was titled
Gay Flag is a sign of “Life” in the Lobby of a Catholic Hospital
http://tomorrowstrust.ca/?p=3071
Lifesitenews took exception to its presence. It is just the kind of thing with which the Church’s move to the right has no patience. It is also another example of an area that a Catholic hospital smack in the middle of a large Gay demographic area has to wrestle.
Perhaps Catholic hospitals in the USA ought to look at the impact of how Catholic hospitals have responded to the impact of a “universalized government sponsored health care system”in Canada. Who knows they may learn something.
Crystal –
Hmm. That’s the first I’ve heard of that. I went to the USCCB site to check what it says there. The Directive is listed, but you have to order a copy. I wonder why the text isn’t given.
Ann,
I had read about this just after the US Bishops’ recent meeting, but hadn’t read the actual directive, or the CHA statement about it. Just looked them up. It doesn’t really sound as bad as the news story I linked to in my earlier comment made it sound. here is – Issued by the United States Conference of Catholic Bishops, November 17, 2009, Ethical and Religious Directives for Catholic Health Care Services, directive 58 …
58. In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the ―persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care.40 Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be ―excessively burdensome for the patient or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed.‖41 For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.
And here below is the CHA statement about it ……
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The Catholic Health Association of the United States (CHA), founded in 1915, supports the Catholic health ministry’s commitment to improve the health status of communities and create quality and compassionate health care that works for everyone. The Catholic health ministry is the nation’s largest group of not-for-profit health systems and facilities that, along with their sponsoring organizations, employ more than 750,000 women and men who deliver services combining advanced technology with the Catholic caring tradition. For more information, visit the CHA website at http://www.chausa.org.
CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES STATEMENT
COMMENT REGARDING REVISION TO DIRECTIVE 58 OF THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES
WASHINGTON, DC (November 18, 2009) – The following statement is being released by Sr. Carol Keehan, DC, president and chief executive office of the Catholic Health Association of the United States (CHA):
The revision of Directive 58 of the Ethical and Religious Directives for Catholic Health Care Services approved by the United States Conference of Catholic Bishops on November 17, 2009 is actually a clarification of the meaning of a “presumption in favor of providing nutrition and hydration to all patients” that was part of the former Directive 58. The revised Directive makes this clarification in light of Pope John Paul II’s 2004 address and the Congregation for the Doctrine of the Faith’s 2007 statement. As such, the revised Directive does not offer new teaching but rather reflects existing Church teaching which Catholic health care facilities have already incorporated into their practice.
The new Directive 58 makes three points:
1. There is a general moral obligation to provide patients with food and water, including medically administered nutrition and hydration for those who cannot take food orally.
2. This general obligation extends to patients in a persistent vegetative state because of their fundamental human dignity. However, the Directive explains that this obligation ceases and the measures become “morally optional” when the measures cannot reasonably be expected to prolong the patient’s life or when they become excessively burdensome. (This provision incorporates into the Directive the teaching of Pope John Paul II and the Congregation for the Doctrine of the Faith regarding medically assisted nutrition and hydration to persons in a persistent vegetative state. Catholic health care facilities have already addressed the implications of these statements).
3. The Directive also distinguishes between patients in a chronic state and those who are dying. This distinction has implications for the use of medically administered nutrition and hydration. For dying patients, medically administered nutrition and hydration may no longer be of benefit and may, in fact, impose significant burdens.
In sum, while upholding the general obligation to provide nutrition and hydration to patients, the revised Directive also makes critical distinctions regarding their use. It does not state that all patients must always be provided with medically administered nutrition and hydration.
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Crystal…that is just false and, quite frankly, obviously false to anyone who actually read the revised directive:
“In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the “persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care. Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be “excessively burdensome for the patient or (would) cause significant physical discomfort, for example resulting from complications in the use of the means employed.” For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.”
It actually spells out several examples where one would could forgo or discontinue ANH. Furthermore, what Roman Catholic moral theology generally allows the patient or her surrogate to determine what counts as ‘burdensome’ treatment.
I can understand a desire to engage on whether ANH should have some special status as ‘in principle’ ordinary (quick frankly, I share this worry), but it is hard to see how posting fact-free attacks on the Bishops’ position is helpful here.
Sorry – I had posted the link to the new story without actually reading the directive 58 first. But check out directive 59 …
59. The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.
Right, the new wording remains unclear in one increasingly large demographic of patients–those with advanced dementia. I understand that an Alzheimer’s patient who has lost the ability to swallow (usually after any apparent ability to communicate with others is gone,) may live for several weeks or months with a feeding tube. So…are those patients “drawing close to inevitable death,” and so can be left without ANH, or is this condition “chronic,” and so they must have the tube? In part, it depends on whether you put the tube in or not.
It’s not all that different with PVS. PVS itself is “chronic,” because one doesn’t die immediately of it, unless of course one were to forgo interventions such as ANH. Absent ANH, PVS is a condition in which one “draws close to inevitable death,” yes? So we mandate an intervention which causes a fatal condition to become chronic, despite ample evidence that the patient will never recover, and the family will eventually bless whatever bacterial infection comes along for which they can decline penicillin.
The dictum “feed those who can benefit from feeding” leaves out of the loop the most important issues of what benefit might be expected for the patient and the family. Neither the PVS patient nor the Alzheimer’s patient will ever recover to meaningful relationality. The equipment one needs for that is destroyed, and once it’s gone, it’s gone. So in what way is ANH beneficial to these patients, unless we posit that mere biological continuation of life is the ultimate good one can hope for? And in what way is that a Christian attitude toward life and death?
The lack of definition in the bishops’ statement is likely to be most pastorally harmful to those least capable of doing anything about it–ordinary Catholics who want to follow Church teaching, but who don’t want to see their loved ones subjected to long term futile “treatment.” Add to this the tendency of some docs in Catholic hospitals to interpret Church teaching with a rigorist slant (like the guys in–was it Nicaragua?–who let a woman bleed to death rather than give her an emergency D&C because that might count as an abortion?) and you have a situation in which the humaneness and flexibility of the teaching on burden and benefit is lost.
Thank you, Lisa and Crystal. All this just confirms my decision to avoid a Catholic hospital. My fear is the concrete person becomes an abstract exercise for the speculations of moral theologians.
I am uncomfortable leaving it to bishops to decide how much redemptive suffering they believe is appropriate for me. I might conceivably choose the most painful alternative available, but that needs to be MY or my surrogate’s prayerful decision before God.
Lisa wrote
“So in what way is ANH beneficial to these patients, unless we posit that mere biological continuation of life is the ultimate good one can hope for? And in what way is that a Christian attitude toward life and death?”
Lisa, you said a mouth full. Somewhere, in the past I think there was a heresy based on this premise. Maybe a theologian in our mist could verify this?
None the less I think this is where we are at in the current USCCB statement and many in the ultra pro-life camp. We no longer discuss the spiritual nature of Humanity as that which makes us in the Image of God but rather merely the simple existence of our human cellular structure.
Carolyn, this has been a most informative discussion and I certainly can sympathize with your position.
By the way, did we ever hear from Peter or Unagidon on this thread? Just asking?
Thanks, Crystal for pointing this directive out:
:59. The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.”
If there is anything the discussions on this blog have made clear to me it is that Catholics do not all agree on how to apply Catholic moral teaching to various medical situations. And the Bishops’ directives on this point appear to be written in such a way as to support various interpretations. (Some read the directive on chronic vegetative state to be open to withdrawal of support, since death is inevitable, but it clearly can be read to the contrary.) I would not wish to be at the mercy of someone who might, in the light of what THEY take to be a “correct” interpretation of Catholic moral teaching, override my own free and informed judgment concerning the use or withdrawal of life-sustaining procedures, so I am with Carolyn and Ann on this one.
Random thoughts on reading more directives:
Re: Directive #71:
“The possibility of scandal must be considered when applying the principles governing cooperation. Cooperation, which in all other respects is morally licit, may need to be refused because of the scandal that might be caused.”
There is something disturbing about the fixation of bishops on the avoidance of scandal versus an act itself as the source of the problem. I can’t help thinking of cover-ups and worse, given the record of diocesan bishops in holding “final responsibility for assessing and addressing issues of scandal…”
Re: Footnote #19:
“It is RECOMMENDED that a sexually assaulted woman be advised of the ethical restrictions that prevent Catholic hospitals from using abortifacient procedures”
Reminiscent of the symphysiotomy post that begins this thread, where women were not informed of treatment parameters, why is it only recommended instead of MANDATED in the directives that a sexually assaulted woman be advised of ethical restrictions about abortifacient procedures?