Willing and Unable: Doctors' Constraints in Abortion Care

Chapter 6: Abortion Prohibitions and Miscarriage Management in Catholic-Owned Health Care

118 Chapter 6 abortion prohibitions and miscarriage management in Catholic-owned health Care dr. brian smits decided to pursue a fellowship in perinatology when he graduated residency in the late 1990s because male ob-gyns were “just not finding jobs.” Female patients had become increasingly interested in having female physicians. But that was not the only reason he decided to subspecialize. “I really enjoyed high-risk obstetrics,” he explained, “because it is a little bit of medicine, it’s a little bit of surgery. There’s a lot of variety so it keeps you from getting bored.” When he returned to the East Coast, where he planned to settle down after his fellowship, he found a job in a Catholic hospital. He described himself as a bit “naïve” about the job search process. He had substantial experience doing abortions during his residency and fellowship, but he needed employment and therefore signed a contract with prohibitions on abortion and other reproductive health services. “I took a job which I was a little nervous about,” he said, “and I was right. I initially started out at St. Mary’s, which is Catholic . . . It was in my contract that if I discussed birth control, abortion, did an abortion, a tubal ligation, then it was grounds for immediate termination of employment, and, you know, ‘you will practice your medicine by the guidelines of the Roman Catholic Church’ . . . and that’s actually what caused me to leave St. Mary’s.” Many non-Catholic health practitioners, like Dr. Smits, work in Catholic hospitals in the United States. Catholic hospitals were established in abortion prohibitions and misCarriage management 119 this country during the late nineteenth century, as were Jewish hospitals, to better serve their constituencies in the face of pervasive discrimination. Catholics in particular were concerned about their patients not being able to receive their last rites and being pressured to convert to Protestantism at crisis moments (Starr 1982). But it was not long until both Jewish and Catholic hospitals began to serve people of all faiths (white people, that is; they still denied admission to blacks). Over the past century, a variety of religious hospitals have come to serve and employ people of all denominations and racial and ethnic backgrounds around the United States. Catholic hospitals have stood out, however, in both their numbers and policies. Nearly 70 percent of religiously affiliated U.S. hospitals are Catholic (Uttley and Pawelko 2002). The Catholic Health Association reports that its members constitute 12.7 percent of the nation’s hospitals, operating 15 percent of the nation’s hospital beds; and in Washington, D.C., and the twenty-one states where they are most well established, they account for more than one-fifth of hospital admissions (CHA 2009). They are also the largest single group of not-for-profit hospitals in the country (CHA 2009). But unlike the Jewish, Presbyterian, Methodist, and Episcopalian affiliated hospitals, which have generally operated in a nonsectarian manner, posing few or no constraints on patients’ abilities to obtain health-care services (Uttley and Pawelko 2002), Catholic hospitals have as their mission “to serve those in need and transform society on behalf of Jesus and the Catholic Church” (Place 1998), which includes requiring that treatment be consistent with “Catholic moral principles”(CHA 2001) through the omission of certain reproductive health and end-of-life services. Since the 1990s, Catholic health care around the United States has grown tremendously as Catholic-owned hospitals purchased or merged with numerous nonsectarian hospitals (Uttley and Pawelko 2002). The lay press, legal scholars, and social scientists have discussed the effect these mergers have on patient care, particularly women’s reproductive health care (Brooks 2006; Fogel and Rivera 2004; Gelb and Shogan 2005; Joyce 2002; Labi 1999; Palley and Kohler 2003; Sloboda 2001; Vitello 2006). This literature has focused largely on Catholic health-care policies prohibiting contraception, tubal ligation, sterilization, emergency contraception , and abortion. Medical journals have shown interest in the broader 120 Willing and Unable concerns of a physician’s right to refuse, refer, or inform patients of services to which they have religious objections (Charo 2005; Curlin et al. 2007), but few articles in the medical literature to date have addressed the effect of Catholic hospital policies on patient care and the professional conduct of physicians (Bellandi 1998; Gallagher 1997). Although other hospitals may also restrict or prohibit certain reproductive health services, evaluating the practices of...