Whether by insurance or preference, Catholic health care’s presence in the United States is hard to ignore. In a recent report from the Kaiser Family Foundation, the authors noted that 16 percent of all hospital births occur in Catholic facilities. In some states, the share is even higher: 33 percent in Oregon, 35 percent in Missouri, 41 percent in Oklahoma and an astounding 61 percent in Washington.
Catholic health care is also at the center of ideological debates. Some, including the authors of the K.F.F. report, argue that Catholic hospitals and clinics are too restrictive in the care offered. (“The Catholic Church’s directives are often at odds with accepted medical standards, especially in areas of reproductive health, according to physicians and other medical practitioners.”) One of the K.F.F. authors, Rachana Pradhan, was interviewed on March 17 on PBS News Weekend; there was no corresponding interview with a Catholic health care representative.
Others worry they will not remain consistent in applying church teaching to complex care. For example, on the website Catholic Answers, the author Trent Horn urges Catholic hospitals to explicitly reject gender reassignment treatments that “promote mutilation of the body in order to appease a culture that has lost its grip on the reality of our having been made ‘male and female.’”
The questions surrounding Catholic health care are often centered on issues surrounding the beginning of life, such as access to contraception and abortion.
As an ethicist, I have seen the kinds of cases that prompt such questions. I am called on to advise parents on how to best care for a baby at the margins of viability, and I have stood at the bedsides of pregnant patients and families as they learn that there are significant complications for the patient and the fetus. Catholic health care has found innovative solutions to improve maternal and infant outcomes in these cases because the Ethical and Religious Directives for Catholic Health Care Services instruct us to provide prenatal, obstetric and postnatal care consonant with our mission (E.R.D., No. 44). Those of us who work in Catholic health care do so not in hopes of denying care, but because we are responding to a need. We desire to improve the health of our communities.
Those who narrowly assess the quality of Catholic health care based on the availability of certain procedures would benefit from a deeper examination of the good being accomplished every day. One example is the commitment to educating clinicians to identify cases of human trafficking and to intervene to help victims (going beyond responses like distributing contraceptives and providing abortions, which do not address the roots of the problem). This commitment directly follows in the footsteps of the women religious who founded many of our health care organizations. Another example is the work of Catholic health systems, with local community health and social service organizations, to address racial disparities in infant and maternal mortality.
At the same time, even some Catholics may need reminding that Catholic health care must attend to our social tradition as well as to our moral tradition regarding specific procedures. The promise to save lives is meaningless when, for example, a person needing care is turned away simply because of their immigration status. Catholic health care has a particular obligation to attend to the vulnerable, and one way is by providing training opportunities for persons resettling in the United States.
With rising health care costs, we may see worse health outcomes as people delay seeking care and their social needs go unaddressed, and that is a concern for Catholic institutions. When Cardinal Joseph Bernadin spoke about the “consistent ethic of life” in 1983, he did not teach only about the preservation of life; he said that one should also be committed to enhancing the quality of life. We see this ethic reflected in Catholic health care systems advancing the role of palliative care and contributing to important initiatives like value-based care, which encourages economic efficiency by aligning payment with health outcomes for all Medicare-recipient hospitals in the United States.
Evidence-based care
Catholic health care also has a proven record in applying evidence-based care that is holistic in practice, meeting the needs of both the patient and their family, and that leads to a more equitable distribution of health care resources. This care includes improving transportation services for patients, shortening wait times at clinics, finding physicians who can represent the communities they serve, implementing anti-racism clinical practices, and offering help to parents so that situations at home do not deteriorate to the point where child welfare agencies must intervene.
During the early days of the Covid-19 pandemic, Catholic health care led the way by working with both religious and secular institutions, as well as community groups and academic institutions, to ensure equitable care and the distribution of vaccines and other resources. We need to replicate that type of collaboration in other areas of need, including medically underserved rural, urban and frontier communities.
Hot-button political issues should not distract us from the almost 20,000 babies who die every year from birth defects, preterm birth, low birthweight, sudden infant death or complications during pregnancy that could be preventable. As a maternal and child health researcher, I have studied the burden of inadequate prenatal care, which can lead to adverse birth outcomes like preterm birth, low birth weight and death before the age of 1. Approximately 700 women die in the United States each year as a result of pregnancy or its complications, and there exist significant racial and ethnic disparities in pregnancy-related mortality. We need Catholic health care to serve the most vulnerable among us, those who may have high insurance deductibles or may not be able to choose their health care providers. A myopic focus on a few reproductive health procedures ignores broader questions about health care delivery for populations at risk for discrimination, inequity and disengagement.
Nevertheless, we should take criticism of Catholic health care seriously, and we need people to ask whether Catholic health care is living up to the community’s expectations. So much of the work of ethicists entails resolving challenges when we come from different points of view, and being open to engaging new models. Just as Cardinal Bernardin invited us to be transformational about honoring the dignity of all persons, we need to think more expansively about how to ensure just and equitable care.
Culture war fights around abortion ignore broader questions about health care delivery. Secular and Catholic institutions should instead collaborate on providing just and equitable care (and Catholic institutions may need to do a better job informing people about their work). We do not need to villainize each other or trade or one-liners about what is right or wrong.
Finally, if you are a patient at a Catholic health care facility, or are acting on behalf of a patient, remember that you can request a clinical ethics consultation to answer any questions about particular issues. We ethicists are not here to inhibit discussion. We are here to collaborate on achieving the best possible care.
