Catholic health care directives potentially problematic, Hopkins bioethicist says

ACLU claims policies led to 'negligent' patient care in Michigan case

Earlier this month, the American Civil Liberties Union filed a lawsuit alleging that a Catholic hospital in Michigan provided improper and negligent medical care to a woman whose pregnancy was no longer viable. According to the lawsuit, Tamesha Means rushed to Mercy Health Partners when, 18 weeks into her pregnancy, her water broke. The ACLU claims the safest course of action for the hospital would have been to counsel Means that "due to her condition, the fetus she was carrying had virtually no chance of surviving, and continuing her pregnancy would pose a serious risk to her health." Because the hospital neglected to discuss with her the possibility of terminating her pregnancy, the ACLU argues that Means' health was "unnecessarily placed at risk."

As a hospital affiliated with the Catholic Church, Mercy Health Partners must adhere to the 72 Ethical and Religious Directives (ERD) issued for all Catholic health care institutions. These guidelines cover controversial issues, such as birth control, end of life care, and abortion.

Dr. John Haas, president of the National Catholic Bioethics Center (NCBC), rightly notes that the ERD "isn't anything that's uniquely Catholic." As Haas pointed out to ABC News, every professional society has its own code of ethics, which can help to "facilitate with doing the right thing" when members are presented with an ethical dilemma.

Margaret Moon, physician and professor at the Johns Hopkins Berman Institute of Bioethics, told ABC that while she understands that "institutions are allowed to establish their moral values and system of care," the ethics of the situation are complicated when one institution has a "monopoly" in a certain community.

Not all who end up at Catholic medical institutions arrive there by preference—chance ambulance rides or expediency are controlling factors, too. The ACLU lawsuit emphasizes this point when it notes that Mercy Health Partners was "the only hospital within thirty minutes of [Means'] home." Perhaps, though, this begs the question that Haas has already addressed: Is there any hospital Means could have chosen that doesn't have ethical guidelines in place?

According to ABC, Haas questioned the central argument of the ACLU's lawsuit, which alleges that Means' doctor didn't discuss the full range of treatment options because of the ERD. As ABC notes:

Catholic directives do ban abortion, except in cases where the pregnancy endangers the life of the mother. Haas said the medical case as described in the lawsuit, would appear to be a case where abortion would be allowed under the directives. "If that hospital had called [the NCBC's 24-hour hotline] and said may we proceed in terms of starting labor … it's perfectly legitimate," to save the mother, said Haas.

… Haas points out that the directive 27 says the patient should be given "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 alternatives, including no treatment at all," in order to make informed decisions.

Dr. Moon worries about the phrase "any reasonable and morally legitimate alternative," which she sees as a loaded term.

Moon said that a doctor in a Catholic hospital could in theory not consider an abortion to be a "reasonable and morally legitimate alternative" for certain medical conditions, while other hospitals might recommend that as one treatment option.

"They've taken the notion of informed consent and put it on its head. Patients don't anticipate that," said Moon. "The Catholic Church can say a lot of things, but when they're acting in the health care arena, it's necessary the patients working with them understand their care."

The Catholic Medical Association has called the lawsuit "a dangerous, distracting farce," noting that "the ACLU's animus to the Catholic Church and the U.S. bishops is well known." The CMA also notes that almost 13 percent of U.S. hospitals are Catholic-affiliated.

A verdict has yet to be reached in the case of Tamesha Means v. The United States Conference of Catholic Bishops.

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