Criticisms of Catholic health care providers and allegations of inadequate care provided to pregnant women have resurfaced in secular media in the months following the Supreme Court’s Dobbs v. Jackson Women’s Health decision. That ruling, published in June, overturned the 1973 decision in Roe v. Wade. Has Dobbs, which returns policymaking on abortion to state legislatures, provoked the renewed attention?
Mary Haddad, R.S.M., the president and chief executive officer of the Catholic Health Association, a national body representing Catholic health networks and institutions across the country, sees the latest coverage as an extension of a long campaign of resistance to Catholic health care providers. Critics allege that treatment of women can be deficient, and even dangerous during crisis pregnancies, at Catholic hospitals because they are guided by Ethical and Religious Directives for Catholic Health Care Services issued by the U.S. Conference of Catholic Bishops.
In some recent coverage, a reporter for National Public Radio who “grew up Catholic” was surprised to discover that a tubal ligation, a sterilization procedure, was not offered at the Catholic hospital where she delivered her child; a New York Times op-ed in February, anticipating the Dobbs decision, suggested inferior care in a New York Catholic hospital’s emergency room based on the author’s harrowing experience in 2003. In an exemplar of the form of the critical coverage, a report on Oct. 11 in The Washington Post asserts that the Dobbs decision “is revealing the growing influence of Catholic health systems and their restrictions on reproductive services.”
“But quite honestly, nothing has changed. This has always been the way Catholic [health networks] provided care in their communities. It’s not as if we’ve done anything different.”
“They’re trying to get at us for a long time, and now they’re using Dobbs,” Sister Haddad said. “But quite honestly, nothing has changed. This has always been the way Catholic [health networks] provided care in their communities. It’s not as if we’ve done anything different.”
Sister Haddad acknowledges that some services simply cannot be had at Catholic institutions—elective abortions, sterilization procedures, contraception services and gender reassignment therapies and surgeries among them. But, she argues, those restrictions do not mean that Catholic institutions cannot adequately care for women, particularly women in crisis pregnancies.
She points out that the E.R.D.s so often attacked by critics of Catholic health providers do not prevent therapeutic pregnancy terminations or other significant interventions when the health or life of a pregnant woman is threatened. At times, crises emerge that will require interventions that will mean “a fetus being aborted in order to save the life of the mother,” Sister Haddad said. “That is not unusual. And that is acceptable,” according to the ethical and religious directives used by Catholic hospitals.
She described the E.R.D.s as guidelines, not dictates, “for the physicians and clinicians in order to say, ‘How will we respond in situations to ensure the dignity of the person.’” She added, “The health of the mother is uppermost.”
Sister Haddad wonders why any fair observer should be surprised to discover that Catholic institutions would adhere to Catholic teaching on abortion and contraception.
Beyond challenging erroneous assumptions about treatment, she wonders why any fair observer should be surprised to discover that Catholic institutions would adhere to Catholic teaching on abortion and contraception. “Society around us is changing, and at points in time that [criticism] bubbles up, but we have always maintained this sense of integrity in word and deed,” Sister Haddad said. “This is the care we provide because this is who we are, and we’re not shy about that.”
There is much talk these days about personal freedom, she said. “It’s about religion; it’s about freedom; it’s about ‘my freedom and [that] I should be able to do whatever I want.’
“Well, if we’re talking about freedom, there’s religious freedom as well; that’s the Bill of Rights…why the country was founded.” Now, she said, “we need to talk about how religious organizations that are serving our communities continue to function in this environment.”
The issue over the absence of elective abortions and other services at Catholic hospitals has resurfaced, she believes, partly because of some of the confusion that has emerged in the wake of the Dobbs ruling. Ironically, in some instances, Catholic health providers themselves are troubled by the same lack of clarity and anxiety over liability as physicians and clinicians in secular settings regarding treatment of women enduring pregnancy crises.
“The E.R.D.s aren’t restrictive,” Sister Haddad said. “They’re allowing things to happen that some states are prohibiting right now. And that’s going to be an issue for all of us.”
“The E.R.D.s aren’t restrictive,” Sister Haddad said. “They’re allowing things to happen that some states are prohibiting right now. And that’s going to be an issue for all of us.” Brian Reardon, a C.H.A. spokesperson, said the association’s advocacy committee will continue to monitor new state laws on abortion and will be providing guidance to its members on their clinical impact.
Mr. Reardon pointed out that the critical assessments featured in the media typically rely on anecdotal reporting and are unable to cite any peer-reviewed studies that document deficiencies in outcomes at Catholic institutions. A 2016 study conducted by the National Bureau of Economic Research found, not unexpectedly, substantial decreases in sterilization procedures at Catholic institutions but little to suggest concern about standards of care.
“We find some evidence,” the authors concluded, “that Catholic ownership [of hospitals] is in fact associated with a reduction in miscarriages that involve a complication, suggesting that anecdotal accounts may not be indicative of a widespread pattern.”
Many of the communities that secular critics complain are now “dominated” by Catholic health care institutions would not have any health services at all if Catholic institutions had not stepped in.
“Catholic hospitals operating in the United States are accredited and held to the exact same standards as non-Catholic hospitals,” Mr. Reardon said in an email. “In tragic situations when a mother suffers from an urgent, life-threatening condition during pregnancy, Catholic health clinicians provide medically indicated treatment, even if it poses a threat to the unborn child or may result in the unintended death of the child. For example, the treatment of an ectopic pregnancy or a uterine infection are both clinically and ethically required.”
Much has also been made in the secular press about Catholic health care institutions claiming a larger market share in cities and regions across the United States as other institutions close or withdraw. Sister Haddad considers that criticism illogical and unfair.
Catholic orders did not found health services in the 19th and 20th centuries with the goal of “capturing market share,” she points out. “They opened up hospitals and other health services because there was a gaping need among communities that were not otherwise being served,” she said. “That continues to motivate Catholic institutions to this day.”
Many of the communities that secular critics complain are now “dominated” by Catholic health care institutions would not have any health services at all if Catholic institutions had not stepped in when other health providers were unwilling to or after previous institutions had abandoned communities that had not proved sufficiently strong markets, she explained.
“We have a large and stellar history of providing care in communities where no one wants to go and no one wants to stay. This country would be in dire straits without Catholic health care.”
Ongoing challenges remain from long-time antagonists like the American Civil Liberties Union and Community Catalyst—which absorbed the Merger Watch campaign against hospital consolidation under Catholic networks—that seem to object altogether to the very notion of health care institutions guided by Catholic ethics. And more recent challenges like the Biden administration’s emphasis on protecting abortion services and proposed regulations requiring transgender care, have emerged, but Sister Haddad remains confident that Catholic health care providers can weather the impending cultural and bureaucratic storms.
“I look back at what Catholic health care has provided for the people of this country for years, and I think it would be unconscionable for any administration to basically prohibit Catholic hospitals from operating and closing their doors,” she said.
“We’ve got a pretty large footprint,” Sister Haddad said, noting that “in an acute-care setting one out of seven persons is being served in Catholic health care.”
“And we have a large and stellar history of providing care in communities where no one wants to go and no one wants to stay. This country would be in dire straits without Catholic health care. I think people are smart enough in Washington that they’re not going to let that happen.”
Absorbing and adapting to the ongoing criticism is just part of what it means to be in the contemporary hospital business, Sister Haddad said, “part of what is necessary for us to continue serving in this country. We have to figure out how to work within this environment.”
The sisters who founded the institutions that comprise the C.H.A. often faced much worse in the past, she pointed out. “If we think we’re being criticized today,” she said with a laugh, “they were run out of Dodge by shotgun.”
