Catholic Healthcare Is Not the Enemy

catholic-hospital

When it comes to abortion politics—and now contraceptive politics—each side has its favorite demon. Whether it’s the Planned Parenthood Federation of America or the Catholic hierarchy—and increasingly the Catholic health care system—advocates do their best to make the other look as bad as possible, interpreting all events through a glass darkly. (In both cases, curiously, the two ‘demons’ are actually very popular; Planned Parenthood admired as an early advocate of family planning for low income women, and the Catholic health care system for the “sisters” who cared for the poor.)

In the case of Planned Parenthood, anti-choicers cast its founder Margaret Sanger as an unapologetic racist and eugenicist. The fact that she had significant support from black ministers is never mentioned. A superficial study by Life Dynamics of the neighborhoods where Planned Parenthood clinics are located ‘proves’ that Planned Parenthood “targets” black babies for abortion, not that it seeks to provide services black women want and can’t get. A Planned Parenthood receptionist who shouldn’t be counseling oversteps her bounds and gives inaccurate information, or is too casual talking about later abortions, and suddenly she represents national policy.

A woman dies in a clinic that has safely performed tens of thousands of abortions for thirty years; another woman—or ten women—regret their abortions and say they got bad care, bad counseling, were pushed to have an abortion and all clinics are now money grubbing, unsafe abortion mills. Complexity and competing facts never get in the way of a good opportunity to cast the other in the worst possible light. If the demonized do choose to respond, no explanation after the “gotcha” is believed.

The past couple of years have produced a fair number of examples of a similar mindset on my side: we’re right, they’re wrong and the end justifies the means. Significant loss of access to abortion, the success of efforts to stigmatize providers, and the recent attacks on family planning are frightening us and contributing to the desire to destroy the demon.

Recent events in the small town of Bartlesville, Oklahoma highlight an unfortunate use of the oppositional approach by some prochoicers, often bloggers.

First, the facts. On March 28, the Bartlesville Examiner Enterprise (EE) published a story claiming that the only hospital in town—Jane Phillips Memorial Center (JPMC), which is owned by St. John Catholic health system, which in turn is owned by Ascension Health, a larger Catholic system—had told its doctors that they could no longer prescribe contraceptives for the purposes of birth control, but that “they were given the go-ahead to prescribe contraceptives for reasons other than birth control.”

Most of the story was based on anonymous sources, including a patient who’d been told by her doctor that he could no longer prescribe contraceptives either in the hospital or in his own office. While there’s no doubt that a meeting took place, the story lacked clarity regarding who in the chain of command at the hospital had said what at the meeting. It could have been the bookkeeper or the hospital director for all we know.

Advocates in the community organized with the intent to get the decision changed. Their social media efforts went viral, pushing the story to Fox News, and by April 1 it was picked up by The NationSalon.comSlate and influential blogs like Talking Points Memo (TPM) and the ACLU blog. The hospital and the system have been silent* but for an April 1 statement from St. John Health, which read:

Consistent with Catholic health care organizations, St. John Health System operates in accordance with the Ethical and Religious Directives for Catholic Health Care Services, [the Directives] and therefore, does not approve or support contraceptive practices. However, only physicians (not institutions) are licensed to practice medicine and make medical judgments. While our physicians agree to abide by the Directives, they also have the ability to prescribe medications, including hormonal medications, in accordance with their independent professional medical judgment. This includes informing patients when they are operating under their own professional medical judgment and not on behalf of St. John Health System.

One might think this would be the end of the story. And for most news outlets it was. The story never hit the big time. But, in some choice quarters there is a concerted strategy to push two lines of attack on Catholic hospitals. The first is that pregnant women put their lives on the line if they seek services from Catholic hospitals for delivery or complications; the second is that Catholic hospitals and the sponsors of those hospitals (health care systems controlled by religious orders) are part of a deliberate attempt to ensure that women do not get some reproductive health services, particularly contraception. The Catholic Health Association’s efforts to be exempt from the Affordable Care Act’s contraceptive coverage mandate reinforce that belief.

It seemed to me in reading the articles mentioned above that the reporters went out on a limb to describe the Bartlesville brouhaha in the worst possible light and showed little understanding of the Directives they cited—especially what the Directives permit. In short, a political agenda was more important than the facts of the case and more important than understanding and reporting accurately on what the Directives permit or forbid.

Slate and the ACLU blog took the position that the intent of Ascension Health, which controls the hospital, was not to ensure that the hospital was not violating the directives by prescribing birth control, but to deny all women in Bartlesville access to contraception. A headline from the ACLU read: “Wait: Did an Oklahoma Hospital Try to Ban Birth Control Prescriptions for an Entire Town?”

Slate also led with a rhetorical question and answer: “Are the majority of gynecological patients in the small city of Bartlesville, Okla., about to be cut off from access to prescription contraception? That seems to be the conclusion of the local newspaper, the Bartlesville Examiner-Enterprise…” To some extent, questions like this are designed to cover up the fact that the reporter does not know the answer to her own question and for some reason hasn’t bothered to find it.

“The order to restrict contraceptives,” wrote The Nation’s Steven Hsieh, “reportedly came from Ascension Health, a non-profit Catholic health services company that acquired St. John Health System in 2013… Sheila Reynerston, Advocacy Coordinator for the MergerWatch Project, told The Nation that Ascension’s directive to Bartlesville doctors represents ‘an unacceptable intrusion into local health care, denying women the health care they need and handcuffing physicians who want to practice medicine appropriately.’” So the article goes from an unnamed source who says Ascension Health issued the order, to a quote from MergerWatch that implies that Ascension definitively issued the order, an assertion for which there is no proof.

The articles attempt to minimize the statement from St. John Health System that distinguishes the church’s moral opposition to contraception from medical judgment. It notes “only physicians (not institutions) are licensed to practice medicine and make medical judgments. While our physicians agree to abide by the Directives, they also have the ability to prescribe medications, including hormonal medications, in accordance with their independent professional medical judgment.”

TPM’s Lauren Rankin simply ignores this part of the statement, writing that “The Directives strictly state that ‘Catholic health institutions may not promote or condone contraceptive practices’ but encourages natural family planning for married couples.” Generally speaking, misinformation about what is and is not available in Catholic hospitals is rampant. Catholics for Choice, for example, in a memo to colleagues claims that the Directives mean “No access to contraception (Directive 52)” and “No treatment for ectopic pregnancy (Directive 48).”

But Catholic hospitals—which, no doubt, would prefer not to call attention to the provision of prescriptions for contraception by the doctors who work in the hospital—do provide contraceptive prescriptions. And perhaps more than we know. I attended a private meeting some 15 years ago which included two ethicists from Catholic hospitals who made clear that they do not monitor what goes on in the doctors’ offices on hospital premises and speculated that it might even be possible that doctors could prescribe RU 486 in their hospital office without problems (quietly of course).

The Directives require interpretation based on medical advances. To say, as CFC does, that treatment for ectopic pregnancies would not be provided, is untrue. A careful read of the Catholic ethics literature in CHA publications themselves would make clear that a Catholic hospital can even use methotrexate (a drug that can cause an abortion once pregnancy has been established in the uterus) could be sued to treat an ecotopic pregnancy where its mode of action is different and indirect. It has been determined that Methotrexate attacks the DNA in the trophoblastic tissue, not the embryo. Thus its use in ectopic pregnancies is not a direct abortion and is therefore permissible.

Prochoice Catholics have consistently claimed that the church is not monolithic. And yet, it seems that from time to time we all want to paint the “church” with a very broad brush, confusing the position of the bishops with the positions of Catholic health care ministries. We ignore differences so that we can make political points. For example, while CHA argued strongly to be exempt from the contraceptive mandate and for an expansive definition of a religious employer, neither it nor its members have filed a single law suit against the mandate and have accepted the compromise accommodation the administration presented. We ignore the fact that, in response to a demand by the Phoenix Arizona bishop that a local Catholic hospital and then Catholic Health Care West, a large regional system sign an agreement that they would never again perform a specific type of life saving abortion, both refused and both left the Catholic Health System rather than violate their consciences.

By no means am I suggesting that the Catholic Health Association presents no challenges to reproductive health care or that no Catholic hospital ever denies treatment in pregnancy that is best for a woman. Nor am I suggesting that the Catholic bishops are the only adversaries to worry about. I am, for example, offended by the CHA’s claim that it needs to be exempt from the contraceptive mandate and cannot provide insurance coverage. I’m offended because Catholic hospitals can and have provided such insurance to employees before. But I refuse to accept that Catholic health care providers don’t care about women or the poor, or that they’re only interested in money and actively want to deny access to contraception to all women. This kind of oppositional politics is unworthy of both feminism and faith.

Most importantly, it’s time for some of us, particularly people of faith, to move beyond oppositional politics to a post-oppositional frame of mind. On the Feminist Wire, AnaLouise Keating and Lela Map Aryan are engaged in an important discussion of the value of a post-oppositional stance which acknowledges the value of opposition but suggests that moving beyond it would be enriching.

Keating writes:

I’ve been attracted to theories, practices, and people who enact resistance and transformation in non-oppositional ways and seek to create radically inclusive communities–for instance, Ralph Waldo Emerson’s relational philosophy, Gloria Anzaldúa’s spiritual activism, Thich Nhat Hahn’s entire life and teachings, Alice Walker’s definition/practice of womanism.

Keating goes on to note that non-oppositional approaches allow us to find new and creative solutions to polarities. In the reproductive justice and rights communities there is much emphasis on what has failed and is failing and an effort to find new and creative ways to work for what Beverly Harrison called “procreative freedom.” Much of that effort sees religion—especially Catholicism—as the enemy, and, to be sure, many religious people have given them no reason to believe otherwise. But surely people of faith who promote reproductive choice and justice have a way of seeing and experiencing the world that isn’t based on opposition. Come, let us reason together and let us start with no demons.

*The St. John Health System has since released a memo clarifying its policies and positions. Read the follow up here.

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.

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