Catholic Health System Releases New Rules for Contraception

In a follow up to allegations that a Catholic hospital in Bartlesville, Oklahoma had told doctors they could no longer prescribe contraceptives for use as birth control, new rules have been issued that govern the way in which doctors employed in Catholic healthcare system hospitals can prescribe birth control.

The policy memo is clear but a bit arcane, as is the continued prohibition of all contraceptives by the Catholic Church. Using contraceptives when you are not ready to have a child is really the most responsible thing women—and men—can do and Catholic hospitals that do have a commitment to women should be in the forefront of making it as easy as possible to access.

However they are Catholic and finding a way to balance adherence to Church positions with serving women is the tightrope many of them walk. Tulsa World newspaper released a copy of the 5 page memo dated April 17 which lays out the policy on prescribing contraceptives in 6 hospitals they own. It’s reasonable to assume the same rules would apply in other hospitals owned by Ascension.

Ascension Health is the nation’s largest Catholic and largest nonprofit health system, and the third-largest system (based on revenues), in the US. Its Mission-focused Health Ministries employ more than 122,000 associates serving in more than 1,400 locations in 21 states and the District of Columbia, according to its 2012 Annual Report.

The balance is evident. First, the memo states the St. John will not “tolerate” the prescription of medications or devices “for the sole immediate purpose of abortion or whose sole immediate effect is a direct abortion.” Suspicious minds will claim that this means no IUDs which some anti-contraceptive and anti-abortion people think are abortion causing. But if you read it its clear that if the intention of the physician is contraceptive, it is OK.

Secondly, there are repeated references to the fact that St John does not approve, condone or permit—as St. John—the provision of or prescribing of contraception. The system asserts the Catholic position and the ethical Directives. Contraception is bad.

Thirdly, it will tolerate the prescribing of contraceptives by the physicians who work in the hospital so long as they do so as individuals, not employees. It sets out in detail the way in which doctors can do this in the hospital that makes clear they are acting on their own. They need to use their own private prescription pad; they need to give the patient something in writing that makes clear this is a private act, not a hospital act, and they need to give the patient information on natural family planning as well. A bit cumbersome, perhaps, but respectful of the hospital’s obligation to be Catholic and the physician’s right to follow her conscience.

The procedure will be nitpicked—one doctor claimed that some doctors would not be able to prescribe because they don’t have personal prescription pads. Go out and buy one for God’s sake! It will be interpreted as extreme. Tulsa Public Radio described it as a “clamp down on contraceptive prescriptions” when a week ago people were wringing their hands that doctors had been told they couldn’t prescribe at all.

Orthodox Catholics, however, are likely to be outraged that the hospital is actually acknowledging the moral agency of doctors to do what they believe is in the best interest of patients. The memo includes a one-page analysis of the theological basis for cooperation with acts the Catholic institution sees as immoral (there was a good Patti Miller piece on RD on this).

In brief, the hospital critically needs the doctors to fulfill the hospital’s mission. The doctors do not surrender their own moral agency when they come to work with the hospital and the hospital respects that agency. Catholics are not required to prevent all acts contrary to our teaching and need to exercise some common sense in weighing the matters in conflict. In this case having and keeping essential employees or forbidding those employees from acts the doctors see as moral.

Understanding that at least a fair share of Catholic hospitals and systems have these values can go a long way in developing more cooperative models of engagement around difference between those of us who are prochoice and Catholic institutions.

fkissling@gmail.com'

Frances Kissling is a visiting scholar at the Center for Bioethics at the University of Pennsylvania and former president of Catholics for a Free Choice.