Today’s guest post is written by Beth Presswood. This post originally appeared on her blog Atheist Beth and has been reprinted with permission. Content note for discussion of medical horrors, death, pregnancy loss.
I believe that Catholic hospitals should be banned. If the Catholic Church wants to set up a hospital, that’s fine. But Catholic means it follows Catholic Health Directives. These are based ondoctrine and not patient health. No hospital should be allowed to put ANYTHING above patient health.
Well, can’t you just not go to a Catholic hospital? It’s not that simple.
“Between 2001 and 2011, the number of American hospitals affiliated with the Catholic Church grew 16 percent, even as the number of public hospitals and secular nonprofit hospitals dropped 31 percent and 12 percent, respectively, according to an upcoming report by the American Civil Liberties Union and MergerWatch, a nonprofit that tracks religious health care mergers. In 2012, Catholic hospitals and health care systems were involved in 24 mergers or acquisitions, according to Irving Levin Associates, a market research firm. Ten of the 25 largest nonprofit hospital systemsin the country are Catholic, and Catholic hospitals care for 1 in 6 American patients. In at least eight states, 30 percent or more of patient admissions are at Catholic facilities.”
Plenty of people do not live in an area where they could get non-Catholic care within a reasonable drive time.
There are 3 major areas where Catholic Health Directives affect gynecological care.
1. Post-Cesarian Tubal Ligation
Many women have scheduled C-sections for a variety of reasons, including breech position or having had a previous c-section (vaginal birth after c-section is a thing, but the risks should be weighed individually). If a woman knows this is to be her last pregnancy, tying her tubes while her belly is already open is efficient, safe, and effective. The American College Of OB-GYNs says that this procedure is standard of care. If a woman is denied this procedure in a Catholic hospital, she must undergo anesthesia again and faces more risk in the separate procedure. Women denied the procedure at the time of birth have a high rate of unintended pregnancy afterward.
Recently a woman with brain tumors for whom future pregnancy is dangerous was denied a post-cesarian tubal in a Catholic hospital.
2. Ectopic Pregnancy
Ectopic pregnancy is when an embryo implants somewhere other than the uterus, usually in the fallopian tube. It is one of the most dangerous pregnancy complications, as rupture of the tube can lead to catastrophic bleeding. Ectopic embryos are unviable and there is no saving them. There are 3 main treatments for it.
-Methotrexate. This is a drug that has been used in chemotherapy and in regular abortions. Itinhibits the metabolism of folic acid, which will kill the embryo. This treatment is not always appropriate, depending on the size of the embryo and other considerations. This treatment can preserve fertility.
-Salpingostomy. This is the removal of the embryo from the fallopian tube, while leaving the tube intact. It has the potential to preserve fertility in that tube.
-Salpingectomy. This is the total removal of the fallopian tube with the embryo inside. It reduces fertility by at least 50%.
According to Catholic Directives 47-48, ONLY salpingectomy is allowed.
“47. Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.
48. In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”
This means that women walking into Catholic hospitals with ectopic pregnancies may have to accept a riskier and fertility-decimating procedure rather than more appropriate treatments.
According to one study:
“Participants from three Catholic facilities reported that medical therapy with methotrexate was not offered because of their hospitals’ religious affiliation. The lack of methotrexate resulted in changes in counseling and practice patterns, including managing ectopic pregnancies expectantly, providing the medication surreptitiously, and transferring patients to other facilities. Further, several physicians reported that, before initiating treatment, they were required to document nonviability through what they perceived as unnecessary paperwork, tests, and imaging studies”
3. Miscarriage Management
This is the scariest area where Catholic hospitals are failing. You may remember the case of Savita Halappanavar in Ireland. Dr. Jen Gunter explains:
“Without access to the chart, “miscarrying” at 17 weeks can only mean one of three things”A) Ruptured membranesB) Advanced cervical dilationC) Labor (this is unlikely, although it is possible that she had preterm labor that arrested and left her with scenario B, advanced cervical dilation).
All three of these scenarios have a dismal prognosis, none of which should involve the death of the mother.
The standard of care with ruptured membranes (scenario A) is to offer termination or, if there is no evidence of infection and the pregnancy is desired, the option of observing for a few days to see if the leak seals over and more fluid accumulates…I, however, I have never heard of a baby surviving in this scenario. Regardless, if infection is suspected at any time the treatment is antibiotics and delivery not antibiotics alone.
The standard of care with scenario B involves offering delivery or possibly a rescue cerclage (a stitch around the cervix to try to prevent further dilation and thus delivery) depending on the situation. Inducing delivery (or a D and E) is offered because a cervix that has dilated significantly often leads to labor or an infection as the membranes are now exposed to the vaginal flora….the mark of good medical care is that all scenarios are discussed, all interventions that are technically possible offered, and then the patient makes an informed decision. All with the understanding that if infection develops, delivery is indicated.”
In case, you didn’t follow all that, Dr. Gunter explains that ruptured membranes (water breaking) and cervical dilation are dangerous risk factors for infection and the only true cure is removal of the fetus.
There are numerous other cases where the presence of a heartbeat has led to a delay in fetal removal in Catholic hospitals.
A landmark study explains:
“Catholic-owned hospital ethics committees denied approval of uterine evacuation while fetal heart tones were still present, forcing physicians to delay care or transport miscarrying patients to non–Catholic-owned facilities. Some physicians intentionally violated protocol because they felt patient safety was compromised.
Although Catholic doctrine officially deems abortion permissible to preserve the life of the woman, Catholic-owned hospital ethics committees differ in their interpretation of how much health risk constitutes a threat to a woman’s life and therefore how much risk must be present before they approve the intervention.”
Confusion about Catholic Health Directives is often evident, so you may not know how strictly your local hospital adheres to these directives. Some allow uterine evacuation for prevention. Others will make you get sick before offering it.
“the manual of Catholic hospital ethics committees, used to help them interpret and apply the directives, warns, “The mere rupture of membranes, without infection, is not serious enough to sanction interventions that will lead to the death of the child.”6 By contrast, writing in a leading Catholic health journal, other Catholic health ethicists offer a more liberal interpretation of Directive 47: uterine evacuation is indicated if abortion is inevitable and delay will harm the pregnant woman.18Therefore, the former—and arguably more authoritative—source approves of uterine evacuation only after a woman becomes sick, and the latter approves of it as a measure to prevent sickness. Our data indicate that despite Catholic leaders’ desire for strict standardization of Catholic-owned health services, varying interpretations and executions of Directive 47 exist both at the individual (practitioner) and institutional (hospital ethics committee) levels.
Cast studies from “When There’s a Heartbeat”
“Dr B, an obstetrician–gynecologist working in an academic medical center, described how a Catholic-owned hospital in her western urban area asked her to accept a patient who was already septic. When she received the request, she recommended that the physician from the Catholic-owned hospital perform a uterine aspiration there and not further risk the health of the woman by delaying her care with the transport.
Because the fetus was still alive, they wouldn’t intervene. And she was hemorrhaging, and they called me and wanted to transport her, and I said, “It sounds like she’s unstable, and it sounds like you need to take care of her there.” And I was on a recorded line, I reported them as an EMTALA [Emergency Medical Treatment and Active Labor Act] violation. And the physician [said], “This isn’t something that we can take care of.” And I [said], “Well, if I don’t accept her, what are you going to do with her?” [He answered], “We’ll put her on a floor [i.e., admit her to a bed in the hospital instead of keeping her in the emergency room]; we’ll transfuse her as much as we can, and we’ll just wait till the fetus dies.”
This doctor BROKE THE UMBILICAL CORD in order to begin treatment:
“I’ll never forget this; it was awful—I had one of my partners accept this patient at 19 weeks. The pregnancy was in the vagina. It was over… . And so he takes this patient and transferred her to [our] tertiary medical center, which I was just livid about, and, you know, “we’re going to save the pregnancy.” So of course, I’m on call when she gets septic, and she’s septic to the point that I’m pushing pressors on labor and delivery trying to keep her blood pressure up, and I have her on a cooling blanket because she’s 106 degrees. And I needed to get everything out. And so I put the ultrasound machine on and there was still a heartbeat, and [the ethics committee] wouldn’t let me because there was still a heartbeat. This woman is dying before our eyes. I went in to examine her, and I was able to find the umbilical cord through the membranes and just snapped the umbilical cord and so that I could put the ultrasound—“Oh look. No heartbeat. Let’s go.” She was so sick she was in the [intensive care unit] for about 10 days and very nearly died… . She was in DIC [disseminated intravascular coagulopathy]… . Her bleeding was so bad that the sclera, the white of her eyes, were red, filled with blood… . And I said, “I just can’t do this. I can’t put myself behind this. This is not worth it to me.” That’s why I left.”
This doctor refused to check a heartbeat in order to do proper treatment:
” Dr G also circumvented the ethics committee in her southern Catholic-owned hospital. She opted not to check fetal heart tones or seek ethics committee approval when caring for a miscarrying woman for fear that documentation of fetal heart tones would have caused unnecessary delays. This led to conflict with the nurse assisting her.
She was 14 weeks and the membranes were literally out of the cervix and hanging in the vagina. And so with her I could just take care of it in the [emergency room] but her cervix wasn’t open enough … so we went to the operating room and the nurse kept asking me, “Was there heart tones, was there heart tones?” I said “I don’t know. I don’t know.” Which I kind of knew there would be. But she said, “Well, did you check?” … I said, “I don’t need an ultrasound to tell me that it’s inevitable … you can just put, ‘The heart tones weren’t documented,’ and then they can interpret that however they want to interpret that.” … I said, “Throw it back at me … I’m not going to order an ultrasound. It’s silly.” Because then that’s the thing; it would have muddied the water in this case.”
“Doctors told her about being forced to wait to intervene until a woman was at life-threatening risk. “We often tell patients that we can’t do anything in the hospital but watch you get infected,” one said.”
Fortunately, people are fighting back. The ACLU has taken on the case of Tamesha Means, who was denied proper treatment while miscarrying.
“Tamesha rushed to Mercy Health Partners in Muskegon, Michigan, when her water broke after only 18 weeks of pregnancy. Based on the bishops’ religious directives, the hospital sent her home twice even though Tamesha was in excruciating pain; there was virtually no chance that her pregnancy could survive, and continuing the pregnancy posed significant risks to her health.
Because of its Catholic affiliation and bindingdirectives, the hospital told Tamesha that there was nothing it could do and did not tell Tamesha that terminating her pregnancy was an option and thesafest course for her condition. When Tameshareturned to the hospital a third time in extremedistress and with an infection, the hospital once againprepared to send her home. While staff prepared herdischarge paperwork, she began to deliver. Only then did the hospital begin tending to Tamesha’s miscarriage.”
Her lawsuit was eventually dismissed over a technicality, but further litigation is expected.
This post doesn’t even touch on Catholic Directives impacting other areas of care, but just this is enough to think about banning Catholic Directives!