Dear Friends,

Dignity Health (a Catholic health care institution that operates French and Arroyo Grande hospitals) and Catholic Healthcare Initiatives intend to merge, creating a mega Catholic health system that would be among the largest health systems in the nation. As health care institutions merge, we have fewer and fewer choices of where to get our health care. This proposed merger, affecting Dignity Health hospitals across California, could further restrict access to health care, including reproductive health services and end-of-life care. California Attorney General Becerra will be seeking public input on this proposed merger. If you are so inclined, I urge you to attend the meeting and make a brief comment about the impact this merger could have on reproductive health services and end-of-life care. Friday, September 21, 10am at the Ludwick Community Center, 864 Santa Rosa Street, San Luis Obispo.

Are you aware that Catholic hospitals function according to a set of rules that you may not agree with? It’s called the “Ethical and Religious Directives for Catholic Health Care Services” (ERDs) Here is the June 2018 edition for all to see: ,.

One in six hospital patients in the United States is now treated in a Catholic facility, according to the Catholic Health Association. Nevertheless many Catholic systems have names like Mercy, Dignity, Trinity, Ascension, and SSM Health that do not identify them as Catholic and many people have no idea that some hospitals are Catholic and operate by their own set of rules. These hospitals usually do not inform patients ahead of time that there are many procedures that are forbidden because the hospital is Catholic. Fewer than 3 percent of Catholic hospitals’ individual websites contain an easily found list of services that are forbidden because of religious rules. Coincidentally, all those hospitals are in Washington state which requires that such information be published on a hospital’s site.

In the past, secular hospitals merging with Catholic health care institutions have sometimes been able to continue offering some forbidden” Immoral” services (like birth control or sterilization procedures) by creating a separate entity as a section within the hospital. The new ERDs specifically forbid this practice.

In any kind of collaboration, whatever comes under the control of the Catholic institution—whether by acquisition, governance, or management—must be operated in full accord with the moral teaching of the Catholic Church, including these Directives.

It is not permitted to establish another entity that would oversee, manage, or perform immoral procedures. Establishing such an entity includes actions such as drawing up the civil bylaws, policies, or procedures of the entity, establishing the finances of the entity, or legally incorporating the entity. “ (ERDs paragraph 74-75)

If you are interested in birth control issues check this out:

The Church cannot approve contraceptive interventions that “either in anticipation of the marital act, or in its accomplishment or in the development of its natural consequences, have the purpose, whether as an end or a means, to render procreation impossible.” Such interventions violate “the inseparable connection, willed by God . . . between the two meanings of the conjugal act: the unitive and procreative meaning.” (ERDs page 16)

Emergency contraception after a rape?

Not allowed unless the local bishop permits it.

Prenatal Genetic testing?:

Only allowed for preparing your mind but not allowed if you would consider pregnancy termination for a severe genetic abnormality. (ERDs paragraph 50)

How about infertility treatments?:

Nope. No IVF, GIFT, ZIFT, Intracytoplasmic Sperm Injection or any other treatment that involves fertilization of the egg outside the body. No treatment that uses surrogates, donor eggs or sperm. No treatment that involves the production of embryos that might later be destroyed. (ERDs paragraph 38-43)

Abortion? My land, no:

Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services…”
Catholic health care providers should be ready to offer compassionate physical, psychological, moral, and spiritual care to those persons who have suffered from the trauma of abortion. (ERDs paragraph 45-46)

What if you have a tubal (aka ectopic or “extrauterine”) pregnancy?

Look out! The usual standard of care is forbidden. That would be either to give methotrexate to cause the pregnancy to die and dissolve without surgery or, if surgery is required, to simply make a small slit over the pregnancy and remove it, leaving the tube to heal on its own. No, what you have to do to follow the ERDs is remove the whole fallopian tube so you can say that you are “removing a diseased organ” and the “destruction of a viable fetus” is simply a side effect of your surgery (ERDs paragraphs 45 and 46)

End of life care:

Voluntary stopping of eating and drinking?:

NO! “A person has a moral obligation to use ordinary or proportionate means of preserving his or her life.” And

there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the “persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care.” (ERDs paragraph 56 and 58)

Don’t count on that advance directive either:

The institution, however, will not honor an advance directive that is contrary to Catholic teaching.” (ERDs paragraph 24)

And if you had the foresight to name a medical proxy, or surrogate, in case you are unable to speak for yourself:

Decisions by the designated surrogate should be faithful to Catholic moral principles (ERDs paragraph 25)

Death with Dignity”:

And, of course, anyone associated with any Catholic health care institution is strictly forbidden to participate the CA ‘death with dignity’ law which permits physicians to provide medical aid in dying to mentally competent adults who are terminally ill and who request it (ERDs paragraph 60)

Are you thinking that some of the Dignity hospitals aren’t, strictly speaking, “Catholic” hospitals and provide care according to a more relaxed set of standards? That is now forbidden by the new (June 2018) ERDs:

In any kind of collaboration, whatever comes under the control of the Catholic institution—whether by acquisition, governance, or management—must be operated in full accord with the moral teaching of the Catholic Church, including these Directives. (ERDs paragraph 74)

In many instances, hospital clinicians such as nurses and doctors are not allowed to discuss all available options with patients or to refer those patients to another facility where what the ERDs consider to be “immoral” services may be given. It’s up to the Bishop (based on the ERDs part 6)

And my personal favorite:

Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.” (ERDs paragraph 61)

If this disturbs you, try to make it to this meeting.

Friday, September 21, 10am
Ludwick Community Center
864 Santa Rosa Street, San Luis Obispo.

Thank you.

Susan Robinson, M.D., F.A.C.O.G

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