Should religious dogma override a doctor's opinion on a patient's need or desires? It's a question that is increasingly plaguing health care providers across the nation, especially in the area of reproductive medicine, as a major player in the hospital industry -- the Catholic Church -- asserts its influence over decisions at its institutions.
Needless to say, abortions are taboo in most locations but even in several major dioceses when that may be necessary to save the life of a mother, doctors and administrators are being told that performing them could and probably will mean the loss of affiliation. In Phoenix in 2009 a bishop excommunicated a distinguished long-time administrator, Sister Mary McBride, for permitting an abortion at St. Joseph Hospital even though a team of doctors had counseled that it was the only way to save the mother's life and despite the fact for more than a 100 years the church permitted termination under those conditions.
When the bishop demanded that the hospital forgo any further such activity and apologize, the board refused and Bishop Thomas Olmstead decertified the hospital as a Catholic institution. Last month, Olmstead told reporters that he had not wanted that action, but that the "faithful of the diocese have a right to know whether institutions of this importance are indeed Catholic in identity and practice."
But terminating a pregnancy is only the most dramatic of conflicts between the church and the medical profession's oath to provide whatever assistance is necessary. More and more bishops are including such practices as tubal ligation to prevent further pregnancies and an array of other women's services including fertility treatments on a list of banned procedures in the church's hospitals. This might not seem so serious if it weren't for the fact that a large number of the nation's churches are Catholic and they exert a great deal of influence in states with substantial numbers of parishioners who subscribe to the church's edicts.
Montgomery County, Md., one of the nation's wealthiest and best educated venues in the nation, decided to award a permit for the construction of the first new hospital in 30 years to Catholic Holy Cross Hospital rather than to Adventist HealthCare. The granting authority's decision was overwhelming despite a large number of protests over concern about the action's impact on reproductive services. Maryland is a heavily Catholic state. Consolidations between religiously affiliated hospitals and secular ones have grown substantially because of economic conditions. The denominational facilities bring with them an adherence to church directives and a further erosion of patients' medical rights in those facilities.
For the average lay person, of which of course I am one, it is becoming increasingly difficult to comprehend mindless adherence to doctrine that outlaws any medical procedure that is legal, ethical and based on sound judgment. If a physician warns that a pregnancy would seriously jeopardize a woman's life and the only sure way to prevent that would be to tie her tubes and she decides to accept that advice, should a religious directive supersede that? Such interference would be extremely difficult to accept, particularly if there is no other medical facility available and even if the woman and her husband or significant other are devoted to their church. Should that devotion extend to what could be a death penalty?
These certainly are questions more and more doctors and their patients are being forced to confront. In fact, according to recent news reports, doctors are coming under pressures they never anticipated. Religiously affiliated hospitals have played a huge role in the advancement of medicine in this country. But religious zealotry that refuses to acknowledge any diversion from dogma no matter how necessary is counterproductive to the cause of sound medicine.
One can understand the refusal to permit affiliates to perform some legal procedures that are not life threatening even if the doctor believes this would be to the patient's advantage in the long run. But the second the matter becomes one of critical importance, the church's directives seem to me to lack any authority in the decision. It would be far better if the church's top authorities sit down with hospital officials and hammer out a new sensible solution that applies uniformly and mandatorily.
Dan K. Thomasson is former editor of the Scripps Howard News Service.