Last week, hospitals across WA State submitted their policies to the WA Department of Health and began posting them on their web site. PeaceHealth, which operates tax-supported hospitals in several areas around the state, has now provided written proof which makes clear it follows the Ethical and Religious Directives for Catholic Health Care and is enforcing these directives on physicians and patients.
You can find a link to the complete set of policies here.
Meanwhile here are some excerpts and analysis of the PeaceHealth policies as they apply at PeaceIsland Medical Center in Friday Harbor, Washington, and at other hospitals around the state. (The PeaceHealth facility in Friday Harbor is specifically cited because PeaceHealth negotiated a 50-year contract where it gets a direct tax subsidy from San Juan Island property tax owners even as it retains the right to deliver only those services which fit its mission and values.)
On Death with Dignity and Other End-of-Life Policies
Increasingly, PeaceHealth and other Catholic institutions are now forbidden from using the language “Death with Dignity.” From conversations with physicians and others, they are being directed to use the description “euthanasia” or “physician-assisted suicide.” In its policies, PeaceHealth specifically cites the Ethical and Religious Directives, 5th edition, before saying:
“Assisted suicide, even if legalized, violates both human dignity and the common good and does not respect the sacredness of life that is fundamental to Catholic Health Care ministry.”
Here’s what else PeaceHealth has to say on the topic:
“PeaceHealth recognizes death as a part of life and, as such, does not participate in or in any way support the hastening of the end of life through euthanasia.”
“PeaceHealth caregivers must not provide referral information to patients or famillies about organizations that actively participate in the arrangement of Physician-Assisted Suicide, however, PeaceHealth does not prevent patients from seeking information on Physician Assisted Suicide from available community resources.”
So PeaceHealth now makes clear that it will refuse to provide information or referrals to any physicians or entities that actively participate with Death with Dignity, but thankfully at least PeaceHealth employees won’t take a computer or cellphone away from a dying person to prevent him/her from accessing the information on his or her own.
PeaceHealth’s hard line against any participation with Death with Dignity should be troubling to the 75% of San Juan Islanders who voted in support of the Death with Dignity statute. And it doesn’t stop there. PeaceHealth also refuses to honor Advance Directives that “conflict with Catholic doctrine.”
Catholic doctrine requires that people in persistent, vegetative comas be kept on feeding tubes. Alarmingly, among some Catholic ethicists, a new front is also developing against the use of “palliative sedation,” which is a way of inducing sleep when you have a horrible end-of-life illness and pain medication won’t help. (This can happen with a terminal brain tumor known as a glioblastoma, for example.) The reason that “palliative sedation” is now being targeted and discussed among Catholic ethicists (and physicians and caregivers who are required to listen to them), is that palliative sedation does not allow the patient to fully experience redemptive suffering in a way that can bring him/her closer to God. Some Catholic ethicists also promote the idea that suffering benefits the caregiver. In a paper presented at the University of St. Thomas in Minnesota entitled “Recognizing the Value of Suffering in Caring for Terminally Ill Patients,” Catholic philospher and bioethicist Jason Eberl states, “Caregivers are inspired to perform acts of love and compassion toward a suffering patient, which yields the development of virtue in them.”
As someone who was at the bedside of my mother and sister in their final moments, it never occurred to me that development of my virtue should have any bearing on how much pain reliever my mother and sister received.
On Abortion and Contraception
First, on abortion, here’s the PeaceHealth policy:
“PeaceHealth does not allow direct abortions. PeaceHealth allows the indirect termination of a pregnancy as a result of direct intervention against a maternal pathology to save the life of the mother.”
As discussed previously on CatholicWatch, when Catholic health care entities talk about removing or targeting a “maternal pathology,” they are generally talking about a situation where there is something discrete like a tumor that can be removed to save the life of the mother without directly targeting the embryo or pregnancy itself. Following is discussion on the topic from the National Catholic Bioethics Center, making clear that the only morally acceptable treatment for an ectopic pregnancy is the removal of the Fallopian tube. To quote the ethicist: “There is always a difference between killing someone directly and allowing someone to die of indirect causes. We may never take the life of an innocent human being, though we may sometimes tolerate the indirect and unintended loss that comes with trying to properly address a life-threatening medical situation.” You can read the full discussion here: http://www.ncbcenter.org/page.aspx?pid=940
It would also be morally acceptable for a fetus encased in a tumor to be removed to save a woman’s life, but it would not be OK to abort a fetus simply because it is causing so much stress on a woman’s body, she will not survive. Tamesha Means, the woman who was turned away from a Catholic hospital in Illinois, even though her water broke prematurely and her pregnancy couldn’t survive, couldn’t get an abortion because it would have involved directly targeting the fetus. Similarly, Savita Halappanavar, the young mother who died in Ireland in 2012, begged for an abortion because, as a medical professional, she understood that her dying fetus needed to be removed or she might die from infection. Instead, she was made to wait until she became infected, and the infection ultimately killed her. She wasn’t fortunate enough to have a tumor or something else that could have been cited as the direct target of an intervention; the pregnancy itself is what needed to be directly targeted to save her life.
Here in WA, we’ve now seen several instances where women in Catholic hospitals have been denied abortions in miscarriage-related situations that put the patient at unnecessary risk. Lori Freedman, a researcher down at UCSF in California recently described a case from here in WA where a woman was denied a D&C at a Catholic hospital even after her physician told her she was miscarrying. He instead ordered a transfusion to treat the symptoms of her heavy bleeding, and then a second one. The transfusions introduced Kell antibodies which could have proved fatal to a subsequent pregnancy. It’s only because the patient was a professional midwife that she understood what happened to her, and especially how crazy and unnecessary it all was: You can read more about the case here: http://www.huffingtonpost.com/lori-freedman/washington-state-case-stu_b_5037035.html
Here’s an excerpt from the policy:
“PeaceHealth does not promote contraception, permanent or temporary. It recognizes that medically indicated exceptions are necessary for the wellbeing of persons and to enable PeaceHealth to contribute to the health of the communities we serve.”
“PeaceHealth requires that natural planning information be available in the settings where PeaceHealth providers serve. Moreover, it is the obligation of PeaceHealth to develop procedures which protect and foster the values of informed consent, freedom of conscience, and the privacy of the doctor-patient relationship. Each facility evaluates contraceptive services the same as other services to insure that patients are receiving quality care.”
So now physicians within PeaceHealth can prescribe birth control for a “medically indicated” exception. As I’ve described earlier, requiring physicians to come up with some reason other than “doesn’t want to get pregnant” encourages them to falsify patient records in ways that are dangerous and troubling. It’s also dangerous for physicians to prescribe birth control and NOT put it into the record, because subsequent medical professonals should have an accurate picture of someone’s health – and that includes knowing what medications a person is on and why.
The prohibition against birth control just to prevent pregnancy also means that patients will not have access to newer long-acting birth control services and/or technologies that have proven to provide the safest, most effective protection against unplanned pregnancy.
And the idea that hospitals should have to discuss “natural family planning” and make such information available is insulting. My mother and other women of her generation endured the fallacy of “natural family planning.” In my mother’s case, it resulted in her being pregnant ten times in 12 years. She only quit getting pregnant after she had a hysterectomy, which may or may not have even been medically necessary – but was the common (and hugely invasive) way physicians tried to help women who simply couldn’t or shouldn’t have more children.
Of course, PeaceHealth also has prohibitions against the use of fetal stem cells and will apply its moral framework to any new treatments that become available as a result of fetal stem cell research. On the discrimination front, PeaceHealth makes clear that it does not tolerate “unlawful” discrimination. This is why it’s so important to understand that under WA State Law, PeaceHealth is exempted from the WA state antidiscrimination laws that protect people’s rights related to marital status and sexual orientation.
To sum up, the newly articulated policies from PeaceHealth are deeply troubling, as is their imposition on physicians and patients in tax-supported hospitals.