When it comes to matters of individual conscience, Washington State voters have a don’t-mess-with-us attitude that makes Texans look like cattle—and it goes way back.
In 2012 Washington voters flexed their muscle by legalizing recreational marijuana use and marriage for same-sex couples. In 2008, death with dignity passed some counties by as much as seventy-five percent. In 2006, Washington lawmakers outlawed discrimination based on sexual orientation and gender identity. In 1991 a citizen initiative established that “every individual has the fundamental right to choose or refuse birth control” and “every woman has the fundamental right to choose or refuse abortion.” It also guaranteed an absolute right to privacy around mental health and reproductive issues for teens aged 13 and up. Washington State’s constitution includes an Equal Rights Amendment and (from the get-go) a stronger wall of separation between church and state than the U.S. Constitution.
These measures have broad support from Washington citizens of all stripes including most religious people. That includes most Catholics, who, in the words of one Seattle parishioner, think that the bishops “need to get over it.”
In other words, west of Moscow, Idaho, and north of Portland, any bishops who want to control what they think of as their sacramental turf –birth, coming of age, sex, marriage, trippy transcendent experiences, and death—haven’t got a chance in hell at the ballot box. Washington even has extended statutes of limitations on child sex abuse—something Archbishop Timothy Dolan successfully fended off in New York and Pennsylvania. The Archdiocese of Spokane declared bankruptcy.
But the Vatican hasn’t survived for fifteen hundred years by being stupid. And as my devout family members like to say, “Where God closes a door, he opens a window.” The window the Bishops found open in Washington takes the form of independent hospitals with financial problems.
Thanks to changes in health care delivery, more and more independent hospitals are being forced to merge with large health care corporations. The pressures include expensive equipment, complex electronic record keeping technologies, and an Obamacare-driven push for greater administrative efficiency. Rather like mom-and-pop hardware stores that survived by becoming Ace franchisees with standardized, streamlined supply and distribution systems, independent health facilities are surviving through acquisitions and mergers with other hospitals and health care corporations.
Of the largest health care corporations in the country, four of six are administered by the Catholic Church including the famously conservative Catholic Health Initiatives which operates the Franciscan brand and has $15 billion in assets. By the end of 2013, if all proposed mergers go through, 45 percent of Washington hospital beds will be religiously affiliated. In ten counties, 100 percent of hospital facilities will be accountable to religious corporations, which are rapidly buying up outpatient clinics, laboratories, and physician practices as well.
In the words of the U.S. Conference of Bishops, Catholic hospitals and health care corporations are “health care ministries” and “opportunities:”
New partnerships can be viewed as opportunities for Catholic health-care institutions and services to witness to their religious and ethical commitments and so influence the healing profession,” . . . “For example, new partnerships can help to implement the Church’s social teaching.”
Here is the diabolical stroke of genius. In any merger between a secular and Catholic care system, fiscal health comes with a poison pill. One condition of the merger is that the whole system becomes subject to a set of theological agreements call the “Ethical and Religious Directives for Catholic Health Care Services” or ERDs. Rather than care being dictated by medical science and patient preference, a set of religious doctrines place restrictions on what treatment options can be offered to (or even discussed with) patients.
Under these agreements, the patient-doctor relationship becomes a patient-doctor-church relationship: “The Church’s moral teaching on healthcare nurtures a truly interpersonal professional-patient relationship. This professional-patient relationship is never separated, then, from the Catholic identity of the health care institution.” Furthermore providers who work in these systems are required to sign binding contractual agreements to adhere to the religious directives, whether or not they are Catholic: “Catholic health care services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives . . . .”
The ERDs in full are readily available to the public, but here are some key samples and implications:
- Fertility Treatment: “Reproductive technologies that substitute for the marriage act are not consistent with human dignity.” This provision excludes in vitro fertilization and related treatments. It especially affects same sex couples, who may rely on surrogacy or insemination for childbearing, but it also affects the 10 percent of American couples who have fertility problems.
- Contraception: “Catholic health institutions may not promote or condone contraceptive practices.” . . . “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.” While we don’t typically associate contraception with hospitals, state-of-the-art long acting methods like IUD’s increasingly are provided at the time of delivery, because post partum insertion improves health outcomes. Under ERD guidelines, a woman who delivers a baby at a Catholic hospital and wants and IUD or to have her tubes tied has to have a second, separate procedure at a secular facility—if they can find one.
- Abnormal Pregnancies: “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.” Catholic practice encourages the removal of the entire fallopian tube to end an ectopic pregnancy, rather than the standard practice which simply ablates the developing fetus. That is because the standard treatment is considered abortion, while in the invasive and fertility-destroying surgery, death of the embryo is simply a side effect. More broadly, Catholic “ethics” forbid abortion even to save the life of a mother carrying a nonviable fetus. The battle to save a young woman named Beatriz, denied an abortion in El Salvador exemplifies this very situation.
- Advance Directives – “a Catholic health care institution . . . will not honor an advance directive that is contrary to Catholic teaching.” Where patient directives and bishop directives conflict, the directives of the bishops take precedence regardless of a patient’s own religious or conscience obligations.
- DNR – “The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.” Since this battle heated up, stories are emerging in which Catholic hospitals have force fed incapacitated patients whose advance directives specifically stipulated that this not happen.
- Death with Dignity – “Catholic health care institutions may never condone or participate in [Death With Dignity] in any way.” Physicians are prohibited even from discussing options that exist in other institutions or making referrals.
To many non-Catholics, the most shocking statement in the ERDs is the suggested alternative to death with dignity: “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.” Redemptive suffering is a theological notion that derives from the crucifixion story—the idea that the blood sacrifice of a perfect being could redeem harm done. (Theories about how this works have varied over the course of Christian history.) By extension, suffering itself has redemptive value, which is why Mother Teresa’s order, for example, practiced self-flagellation and glorified suffering of the poor, ill and dying.
Given the clash between Washington State’s independence streak and the top-down approach of the Catholic bishops, Washington citizens are pushing back. After Catholic Peace Health got an exclusive contract near her home in the San Juan Islands, advocate Monica Harrington created a website, Catholicwatch.org to complement the efforts of the national Merger Watch. Merger Watch has been fighting the religious takeover of secular systems across the country for over a decade, and sometimes winning, but describes a recent surge that overwhelms their resources. The ACLU of Washington is ramping up and aggregating funds to fight for a state-wide solution, the first in the country, and is soliciting stories (confidentiality protected) from patients and providers anywhere in the U.S. who have experienced religious interference in medical decisions.
Even so, on May 20, the Seattle Times announced an affiliation agreement between the University of Washington system and Peace Health. Within Catholic-controlled hospitals, less than five percent of revenues come from the Catholic Church. Most are taxpayer funds in the form of Medicaid, Medicare and capital grants for public services—or insurance reimbursement. So, the thought of the bishops influencing a public owned and funded institution adds insult to injury. In response, Columnist Danny Westneat, of the Times, framed a pointed question. “Most of us aren’t Catholic, so I’m guessing we’d never go along with letting the creeds of that one faith run something as universal as education [even if ‘the Catholics have a good record of running quality schools’]. So why are we allowing it with health care?”
Eight Ugly Sins the Catholic Bishops Hope Lay People and Others Won’t Notice
The Difference Between a Dying Fetus and a Dying Woman
Catholic Hierarchy Lobbies to Suppress Religious Freedom
Self-Flagellation and the Kiss of Jesus–Mother Teresa’s Attraction to Pain
The Freedom to Die in Peace
Anti-Contraception Cardinal Paid Pedofiles to Disappear
Valerie Tarico is a psychologist and writer in Seattle, Washington. She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings, and the founder of www.WisdomCommons.org. Subscribe at Awaypoint.Wordpress.com.
Washington State is now more progressive than British Columbia. I think its time for BC to separate with Washington, Oregon and Alaska and form our own country, Cascadia. http://en.wikipedia.org/wiki/Cascadia_(independence_movement)
I agree. Drop your electoral votes from the real USA.
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Valerie, great piece of reporting, very eloquent and to the point about what could happen to us in Washington State.
Bless you, Valerie, for doing this incredibly important report. You here point out a drastic failure not only in longstanding healthcare laws but in Obamacare: All care, in order to be able to receive any financial support from the Federal Government, must be required to adhere to rigorous standars of care that are established by scientists who receive no direct or indirect funding from any existing healthcare-providing organization, profit or nonprofit. The corruption must be removed, like the cancerous tumor it is.
very interesting piece. one question, about this statement, “Of the largest health care corporations in the country, five of six are administered by the Catholic Church.”
how are you defining health care corporation, and what are the names of the other 5? thanks for any insight.
Did you receive a reply, Joanne? I know that Franciscan care, Catholic Health Initiatives, Peace Health, Providence Care are some of the names of regional/national Catholic health care.
I haven’t received a reply yet. i’m almost certain that united healthcare, Kaiser, cigna and Aetna are bigger, maybe it’s in the definition of healthcare corporation — provider rather than insurer, maybe, but still, Kaiser is a provider.
Joanna, some of these Catholic entities are all across the nation, not just regionally in the West, like I believe Kaiser is. You can find out more about Catholic health care and how it is interfering with community health care by going to http://www.mergerwatch.org .
For Washington State, you can also find information at http://www.catholicwatch.org .
fortune 500 list:
health insurers: (first number is rank in fortune 500, 2nd is annual revenue in millions):
1 UnitedHealth Group 22 101,862.0
2 WellPoint 45 60,710.7
3 Humana 79 36,832.0
4 Aetna 89 33,779.8
5 Cigna 130 21,998.0
1 HCA Holdings 94 32,506.0
2 Community Health Systems 198 13,817.0
3 Tenet Healthcare 272 9,601.0
4 Universal Health Services 339 7,534.1
5 DaVita 359 6,998.9
I can’t find up to date source right now but here is a list from 2009. Catholic Healthcare West is now called Dignity. HCA includes a mix of Catholic hospitals. Tenet is now partnered with CHI. (Franciscan, which Lori mentioned, is a brand of CHI.)
1. U.S. Veterans Affairs Dept $40,686.5 $36,892.1 2. HCA, Inc. $28,374.0 $26,858.0 3. Ascension Health $12,720.6 $11,529.9 4. Community Health Systems $10,840.1 $7,127.5 5. NY Presbyterian Healthcare Sys $8,458.3 $7,387.5 6. Tenet Healthcare Corp. $8,348.0 $8,557.0 7. Catholic Health Initiatives $7,817.1 $7,212.3 8. Catholic Healthcare West $7,596.2 $6,723.5
Read more: Nation’s List of Top Ten Largest Healthcare Systems Include Some Surprises | Dark Daily http://www.darkdaily.com/nations-list-of-top-ten-largest-healthcare-systems-include-some-surprises-113#ixzz2VDrcmVgw
according to your source, “Of the ten largest healthcare systems, three are owned by Catholic organizations and three are for-profit hospital corporations.”
Here are the sources:
I was incorrect – it should have been 4/6, and is now corrected.
There are very few Catholic bishops in Washington. The Catholic hospitals are being taken over by big corporations that can turn a profit. In exchange, the missionaries maintain some identity in the business. Catholic hospitals have never approved abortions. As for DNR as part of advance directions, four of my elders’ requests were honored, one quite recently. For those not wanting Catholic care, there are a majority of non-Catholic hospitals here in Washington. I’m guessing there are some counties without any hospitals, but those are close to both non-Catholic and Catholic services.
This article is misleading and anti-Catholic. As For affordable care, I believe the differences will be worked out so that conservatives and liberals will be able to choose the insurers that fit them best.
Actually, an increasing number of counties have Catholic hospitals–along with affiliated clinics and outpatient practices– and no other option. Whatcomb, for example, and San Juan. By the end of the year, if all approved mergers go through, nine Washington counties will be in this position, and many others will have a majority of care subject to Catholic restrictions. The issue isn’t just abortions. It includes fertility treatment, contraception, transgender care, advance directives, and death with dignity along with treatments that are derived from research practices the bishops don’t approve of, and new biomedical technologies in the pipeline.
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The Catholic Archbishop for Washington State is Sartain, and he is very conservative. He was an appointment by Benedict, and he will want to enforce the Bishops’ ERDs. I have Catholic friends who were very disappointed that Sartain wanted the priests to go back to Latin services.
This is outrageous! Surely–surely!-somebody in Washington will bring a lawsuit that will kick the supports out of this house of cards.
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One might give guarded consideration to a possible upside in that health-care organizations following the US Bishops’ guidelines would also be encouraged to act pursuant to the rest of “Catholic Social Teaching”, which would include such principles as respect and just compensation for workers and caring for rich and poor alike. However, recent events might raise some concerns about even that. A few years back, Catholic health care providers all over the country were furiously cutting back services, closing facilities and selling off properties–often making handsome profits from the real-estate bubble. (One particularly lurid example was the closure of the last remaining Catholic hospital in New York City, in which the employees were given only hours’ notice, personnel records were sealed and the property sold for a huge amount to a developer.) Now, as the ACA goes into effect and many cash-strapped secular institutions are scrambling to deal with it, these same groups are knocking on their doors with pockets full of cash and attractive offers to help out with management, staffing and patient referrals. In this respect, it’s difficult not to view Catholic health organizations as acting like so many other health-care players with respect to “Obamacare”–maneuvering to “work the system” to serve their own agendas rather than do the best job for the public.
Catholic health organizations in Washington are not particularly good at all for their workers. There have been nurses strikes at both St. Joseph’s in Bellingham and another Catholic hospital (forget which one) over benefits – they wanted the nurses to pay more for their copays and more for their insurance package, and at St. J’s in Bellingham they wanted to REDUCE their sick leave hours! And these organizations are supposed to be all about health care! I had this vision of a still-sick nurse trying to care of me in one of their wards!
And “non-profits” are exempt from the Washington Laws Against Discrimination (WLAD) as I believe they are also from federal law, so if an employee is not covered by some kind of union contract that can be in real trouble. There is an article in Seattle’s “The Stranger” by Cienna Madrid titled “Who would Jesus Fire?” (www.thestranger.com and use their search) – it’s chilling what happened to the profiled employees.
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Valarie, thought you might find this news article of interest. It was published today. According to the ACLU lawsuit against the Catholic hospital, she almost died.
Oops, apologies for misspelling your name.
Here’s a copy of the Complaint — and I should note that the complaint is not against the Catholic hospital but against the United States Conference of Catholic Bishops.
Click to access Complaint_Final.pdf
Thank you. It’s really exciting to see this getting national attention.