U.S. Bishops to Vote on Whether to Ban Sterilization at All Catholic-Controlled Hospitals

A “Yes” vote on new health care directives would further reduce reproductive
health services for women in half of the largest health care systems in the U.S.

The National Conference of Catholic Bishops (NCCB) meets this week for a critical vote on whether to put sterilization on a par with abortion and euthanasia as an “intrinsically evil” service and to completely forbid it at any and all Catholic-affiliated hospitals.  At their June 14-16 meeting in Atlanta, 285 U.S. bishops will be asked to approve Vatican-directed revisions to NCCB’s Ethical and Religious Directives for Catholic Health Care Services(Directives).  Drafts of proposed changes to the Directives have been tightly restricted, but Catholics for a Free Choice (CFFC) obtained a copy and found that the revisions explicitly state, for the first time, that “Catholic health care institutions are not to provide direct sterilization, even based on the principle of material cooperation.”

The Vatican has been pressuring the bishops to close a loophole in the Directives called “the principle of cooperation” that has allowed sterilization services to continue at non-Catholic or formerly non-Catholic hospitals when they merge or are purchased by a Catholic facility.  There have been 159 such mergers in the last ten years and Catholic hospitals currently constitute the largest single group of nonprofit hospitals in the US.  With 10 of the nation’s 20 largest hospital systems now Catholic and 20 percent of all hospital beds in health systems owned or controlled by Catholic systems, the new NCCB Directives, if adopted, would affect millions of American women seeking services at Catholic-affiliated hospitals.

“The NCCB’s proposal to ban sterilization is only escalating their attack on women and their access to reproductive health services,” stated Frances Kissling, president of CFFC, an advocacy organization of Catholic people who disagree with the church hierarchy’s positions on sexual and reproductive health and rights.  “By explicitly equating sterilization with abortion, the bishops will restrict the ability of Catholic and non-Catholic hospitals controlled by Catholic hospitals to forge partnerships that allow this service. We call on the bishops to reject these revisions and maintain the existing principle of cooperation that allows women the opportunity to obtain a tubal ligation if they so choose.”

The Catholic Health Association—a trade group interested in preserving existing mergers where sterilizations are specifically permitted or required—expressed grave concerns in the fall of 2000 when drafts of similar revisions to the Directives were made public. The concerns expressed by the Catholic Health Association then are even more valid now. If the bishops vote for the new Directives, community groups and health care authorities will need to review existing mergers to ensure that where provision of sterilization is a matter of contract, it continues to be provided.  For Catholic health care systems, the new Directives present grave legal problems. Nearly all Catholic hospitals receive government funding in the form of Medicare and Medicaid payments.

“A survey commissioned by CFFC found that 85% of women said that any hospital that receives government funding should be required to allow doctors working there to provide any legal, medically sound service the doctors believe is needed,” stated Jon O’Brien, vice president for communication and education at CFFC.

Proposed Revisions to the Ethical and Religious Directives for Catholic Health Care Services  

Current Directive #53 reads:  Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution when its sole immediate effect is to prevent conception. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present pathology and a simpler treatment is not available.

Revised Directive #53, up for vote this week, reads (change in bold):  Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.  Catholic health care institutions are not to provide direct sterilization, even based on the principle of material cooperation. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present pathology and a simpler treatment is not available.

Current Directive #69 reads:  When a Catholic health care institution is participating in a partnership that may be involved in activities judged morally wrong by the Church, the Catholic institution should limit its involvement in accord with the moral principles governing cooperation.

Revised Directive #69, up for vote this week, reads (changes in bold): If a Catholic health care organization isconsidering entering into an arrangement with another organization that may be involved in activities judged morally wrong by the Church, participation in such activities must be limited to what is in accord with the moral principles governing cooperation.

Current Directive #70:  The possibility of scandal (e.g., generating a confusion about Catholic moral teaching) is an important factor that should be considered when applying the principles governing cooperation. Cooperation, which in all other respects is morally appropriate, may be refused because of the scandal that would be caused in the circumstances.

Revised Directive #70, up for vote this week, reads (changes in bold): Catholic health care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically evil, such as abortion, euthanasia, and direct sterilization.

A new footnote to Directive #70 states:  “While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia and direct sterilization.”

A new Directive #71 has been created as follows:

New Directive #71:  October 2000 NCCB Version:  The possibility of scandal must be considered when applying the principles governing cooperation.  Cooperation, which in all other respects is morally appropriate, may need to be refused because of the scandal that would be caused.  Appropriate episcopal authority which has the responsibility for the local Church must make the final decision regarding the presence or possibility of scandal.

New Directive #71:  March 2001 revision, up for vote this week, (changes in bold):  The possibility of scandal must be considered when applying the principles governing cooperation.  Cooperation, which in all other respects is morally licit, may need to be refused because of the scandal that might be caused.  Scandal can sometimes be avoided by an appropriate explanation of what is in fact being done at the Catholic health care facility in question.  The diocesan bishop has final responsibility for assessing and addressing issues of scandal, considering not only the circumstances in his local diocese but also the regional and national implications of his decision.

A new Directive #72 has been created:

New Directive #72:  October 2000 NCCB Revision:  Because of the changing environment in health care, cooperative ventures should be re-evaluated periodically to ensure ongoing consistency with Catholic teaching.

New Directive #72:  November 2000 NCCB Revision, up for vote this week, (changes in bold): The Catholic partner in an arrangement has the responsibility periodically to assess whether the binding agreement is being observed and implemented in a way that is consistent with Catholic teaching.