COMMENTARY

ACLU Says Catholic Hospitals Can Not Refuse to Perform Life-Saving Abortions

Arthur L. Caplan, PhD

Disclosures

November 12, 2015

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Hi. I'm Art Caplan at the Division of Medical Ethics at the NYU Langone Medical Center.

The American Civil Liberties Union (ACLU)—that notorious organization that causes a lot of heartburn for many people—has just filed a lawsuit[1] against the big, Catholic hospital chain Trinity Health Corporation. What they are saying in that lawsuit is that Catholic hospitals should be required to follow federal law and do things that the bishops of the American Catholic Church say they can't do, such as perform abortions, give out emergency contraception, and sometimes do tubal ligations.

The challenge is: Can a Catholic institution be exempt, for reasons of religion or conscience, from what other hospitals are expected to do when the life or health of a woman is in severe danger—usually due to pregnancy? This is not a minor issue. Catholic hospitals account for about 1 in 10 of all hospital beds in the United States, and in some states it is as many as 1 in 5 beds. Ten of the Catholic health systems are in the top 25 health systems in the United States.

Catholic hospitals have done a great deal for the American people. The church's role in health and helping people has been nothing but admirable. At the same time, Catholic hospitals take federal money, including Medicare, and billions of dollars of Medicaid. They get tax breaks because they are not-for-profit entities. More of our health system organizations are becoming affiliated with Catholic thinking because of mergers.

In many parts of the country, mergers are taking place between Catholic hospitals and other hospitals. Oftentimes, Catholic thinking, Catholic doctrine, and Catholic medical ethics start to permeate the health chains or the institutions. The most obvious case—and the one that the ACLU has zeroed in on—is what happens if a woman is dying because of a problem with her pregnancy and it requires an abortion to save her life.

The bishops' teaching on this says you still cannot do an abortion, even if the mother's life depends on it. We have had cases around the United States where the bishops have condemned Catholic hospitals for doing abortions in just such situations, in one instance even breaking ties with the hospital—saying, you can't be connected with the Catholic Health Association because of what you did.

The ACLU says: Look, you can't let bishops—any more than you would rabbis, ministers, or imams—declare what it is that's the best healthcare for any patient. You have to let doctors decide that. Standards have to be set by physicians, not by religious leaders.

Obviously, the Church disagrees and says, there are certain things that Catholic hospitals cannot do. Some of these cases wind up in emergency departments, and there is another federal law that applies here: It is called the Emergency Medical Treatment and Active Labor Act (EMTALA).[2] It simply requires that a patient getting to an emergency department be stabilized and treated. The ACLU says if that treatment requires an abortion to save the life of the mother, then you have to do it. What they insist is if there is no time to look elsewhere, you can't get to another place, and it's an emergency, then you have to require these institutions that are bound by federal law to operate as hospitals to do this.

I side with the ACLU on this one. As much as I respect Catholic thinking and the contribution that they have made to healthcare, you can't ask people—many of whom are not Catholic—to go to the only choice in town and get care that is determined by what the institution is willing to do according to religious tenets. At a minimum, they have to tell you where else you could go or refer you to places where you might be able to get the service you want, if not there. But in some small amount of emergency situations, I think they have to do what secular law requires, not what religious thinking might want to happen.

Conscience is important, and individual organizations have a right to set their own values. No doubt about it. But it's limited by what we agree people have a right to get as a matter of federal law, legislation, and court opinion. The health of women should not be sacrificed for a doctrine that basically is not looking out for their best health interests.

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