Opinion I don’t want your god in charge of my health care
Let’s say a patient is considering a tubal ligation after a planned Caesarean section because she doesn’t want to get pregnant again. Here are some factors that pertain to that decision: her vision of her reproductive future, her doctor’s advice, state regulations, the recommendations of the American College of Obstetricians and Gynecologists, the latest scientific research.
Here are some factors that, for most patients, do not pertain: “God’s purposes,” “God’s will,” “the truth that life is a precious gift from God.”
But if our hypothetical patient happens to be in a Catholic hospital, those factors — precisely those words — will be controlling the decision, whether or not she or her doctor believes in God’s plan. It’s plainly spelled out in the ethical directives of the U.S. Conference of Catholic Bishops: “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.” She won’t get the operation no matter how medically safe and legal it is, no matter what she wants.
Clearly, she should have picked a different hospital. But with the expansion of Catholic health systems all over the country, that might not be an option. A 2020 report by Community Catalyst, a nonprofit health advocacy group, found that four of the 10 largest health systems in the country were Catholic. The Catholic Health Association says that Catholic facilities now account for more than 1 in 7 U.S. hospital patients.
That number is likely to grow, as Catholic health systems expand by merging with or acquiring secular hospitals and networks. This consolidation is happening near me, in the Albany, N.Y., area. As the Times Union recently reported, one of our large health systems, St. Peter’s Health Partners, part of a Catholic network, has begun merging with the secular Ellis Medicine, which will ultimately put “God’s will” in charge of Ellis Hospital and the Bellevue Woman’s Center, which provides pregnancy and maternity care.
That would mean no tubal ligations for contraceptive purposes. It would also mean no abortions, vasectomies, IUDs or in vitro fertilization. It would most likely constrain choices in end-of-life care and end gender-affirming care.
A patient deciding where to have her C-section — even if she still had a choice of hospitals — might not even know this. Why would she assume that a nonprofit hospital, buoyed by large infusions of state and federal funds, could legally withhold health care from its patients?
But that’s exactly what happens when the church has the ultimate say in medical decisions. Not just at hospitals, either: Urgent care centers and physicians’ practices that are part of a Catholic network might well refuse to prescribe birth control, or to provide abortion services or counseling.
New York State has taken pains to protect reproductive rights, beginning with the 2019 Reproductive Health Act, which codified the right to abortion. As state after state passes abortion bans in the wake of Roe v. Wade’s fall, I often think, selfishly, thank goodness I live in New York.
But I still live in the Commonwealth of Religious Deference, where rules can be broken and citizens can be denied basic services as long as someone has decided that’s the way God wants it.
Some lawmakers are pushing back. One recent bill sponsored by New York state Sen. Michelle Hinchey, which has passed the Senate and awaits an Assembly vote, would require that hospitals publish a list of “policy-based exclusions,” detailing the care they will not provide, on their websites. In Oregon, a new law gives state officials the authority to block hospital mergers that would result in restricted health-care access.
But beneath these efforts lies unchallenged the notion that Catholic hospitals are within their rights to deny care. That religious organizations, despite their public funding, do not have to abide by secular standards.
Blue states? Secular country? Doesn’t matter. The most shocking recent evidence that even New Yorkers live in a State of God Knows Best is a devastating New York Times report on the state’s Hasidic schools, which teach Jewish law and tradition but little English or math. In 2019, 99 percent of the thousands of Hasidic boys who took state standardized tests failed. Meanwhile, New York’s yeshivas receive plenty of education funding — “more than $1 billion” in government money over the past four years. Religious leaders systematically denied their students the constitutionally protected opportunity for a “sound basic education,” and political leaders let it happen.
Or at least they did. The New York State Board of Regents recently voted to require private schools to prove they were teaching basic subjects or else risk forfeiting public funding. Whether that rule will be enforced remains to be seen. But it’s a start.
I’d like to see the New York State Department of Health take the same approach to health networks: Prove you are providing patients with all the care that modern medicine has made possible, state law has made feasible and the Affordable Care Act has deemed essential, and you’ll get your tax exemptions and your Medicaid payments.
And if you happen to have a patient who believes contraception contravenes the will of God? She can choose not to get her tubes tied.