In early December, the American Civil Liberties Union sued the United States Conference of Catholic Bishops in federal court on behalf of a Michigan woman, alleging that the bishops’ Ethical and Religious Directives prohibited a hospital from providing medically appropriate care.
Within days, defenders of the Catholic bishops, including the President of the National Catholic Bioethics Center, John Haas, misrepresented what the bishops’ rules require and insisted that “the situation that was alleged to have occurred would not have occurred if the Directives were being followed.”
Archbishop Joseph Kurtz, who heads the Conference of Catholic Bishops, later issued a statement, saying the ACLU’s claims were “baseless.”
It’s important for Washingtonians to understand what’s happening because Washington State has the highest percentage of Catholic ownership and control in the nation, and in many cities and counties across the state, the only hospitals and major health systems are Catholic and subject to the bishops’ rules. Which means that what happens in Michigan matters to Washington.
A careful reading of the Directives and the bishops’ own statements about the Directives makes clear Haas’ assertions are carefully crafted to mislead, shifting blame away from the bishops and onto doctors.
As an example, Haas said that the Directive pertaining to “informed consent” requires that a patient “receive all reasonable information about the essential nature of the proposed treatment and its benefits, its risks, side effects, consequences and cost and any reasonable and morally legitimate (emphasis added) alternatives, including no treatment at all.”
He then went on to say, “If, as this lawsuit alleges, that was not done, then the physician was in violation of the Ethical and Religious Directives for Catholic Health Care Services.”
But the physicians’ hands were tied, because a procedure directly aimed at terminating a pregnancy is strictly forbidden according to the bishops’ own rules (which must be followed as a condition of employment) and would never have passed the “morally legitimate” qualifier Haas quietly slipped into his discussion of “informed consent.”
(Directive 45 says very clearly that “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted.”)
Haas then tried to claim that another Directive, Directive 47, would have provided room for a workaround, because at first glance it seems to give physicians flexibility to treat a “proportionately serious pathological condition” even if it will result in the death of the unborn child.
But the bishops’ own explanation for when Directive 47 applies makes clear it does NOT apply when the danger to a woman’s life results from continuing a pregnancy and not from some other condition, such as cancer. (The example the bishops use to distinguish between when a procedure is and isn’t “morally licit” is that a pregnancy in proximity to a tumor could be excised because pregnancy termination would be a side effect of removing the tumor, but physicians couldn’t act to terminate a pregnancy that simply weakens or stresses a woman’s body to the point where her death is inevitable.) The saga of Savita Halappanavar in Ireland showed to the world last year that the Catholic hierarchy will stand firm on its principles even when it means a young mother with a nonviable pregnancy will die.
Moving forward, the Catholic bishops in the U.S. know that to win public approval and political allies, they have to defend their actions. From Haas statements and those of Archbishop Kurtz, it’s clear the bishops know the American public will never stand by while Catholic hospitals systematically let women die, so they need to come up with an alternate narrative for what’s happening. We’re seeing the seeds of that narrative in what they’ve said so far, and it’s terrible news for doctors who work in Catholic hospitals. Essentially, the bishops’ defense seems to boil down to these claims:
1) When women die or their health is put at risk, it’s the doctors’ fault. They gave negligent care.
2) The Directives are not enforceable policies; they are merely “proclamations” and “teachings”
So even though the Catholic bishops’ directives explicitly state that “Catholic Health Care services must adopt these directives as policy (and) require adherence to them as a condition for medical privileges and employment,” bishops now make the absurd claim that they are not policies, they are only “teachings.” Moreover, their very senior allies (Haas advises bishops on bioethics issues and was commended by the Pope) are already putting the blame squarely on the shoulders of physicians who must adhere to the Directives to keep their jobs and hospital privileges.
The only good news in all of this is that at least physicians here in Washington will be under no illusion about what will happen when things get difficult and women die as a foreseeable result of the Catholic bishops’ own policies: The bishops and their allies will try to duck and cover and put the blame back on the doctors’ shoulders, leaving them to face civil and criminal penalties alone.