Disrupted Directives
Part of the problem has been the Ethical and Religious Directives for Catholic Health Care Services, a publication issued by the National Conference of Catholic Bishops (NCCB) in 1994. The appendix to the Directives contained a section addressing cooperation in immoral acts. Some ethicists criticized the section on cooperation, saying it was far too unclear. The National Catholic Bioethics Center (NCBC) in Boston faulted the bishops for not clearly distinguishing between material cooperation, which is sometimes permissible, and implicit formal cooperation, which is never permissible. The NCBC also claimed that the bishops did not directly address institutional cooperation but only individual cooperation.
The Directives’ section on cooperation allowed for much misinterpretation. For instance, spokespersons for St. Vincent’s in Little Rock claimed the Church’s principle of cooperation permitted participation in an act of wrongdoing in times of "duress," when it was done in order to preserve a greater good. In the case of St. Vincent’s, managed-care companies were said to be applying duress, and the greater good was the hospital’s "financial health." Bayley told me that the Catholic bishops told CHW, "If you need to cooperate with providers who provide sterilization, if you need to do that to make your !hospital system secure—to be sure that your mission goes forward into the future—about that you can negotiate, about that you can cooperate."
Last year the U.S. bishops began revising their Directives at the request of the Congregation for the Doctrine of the Faith, which was particularly concerned about the section on cooperation. The resulting revision, which the NCCB issued on June 15, 2001, remains basically unchanged from the 1994 edition. The bishops added directives on partnerships in Catholic health care and omitted the entire section on cooperation in the appendix. The bishops now said that "reliable theological experts should be consulted in interpreting and applying the principles governing cooperation, with the proviso that, as a rule, Catholic partners should avoid entering into partnerships that would involve them in cooperation with the wrongdoing of other providers."
Rev. Germain Kopaczynski, director of education at NCBC, says that in deleting the section on cooperation, the bishops were responding to criticism that the appendix "was spawning more questions than answers." Was it an adequate response? The Church rarely makes "draconian revisions," Father Kopaczynski says. "I think [the bishops] tried to address the legitimate concerns—that proper doctrine is safeguarded—without changing the document so drastically that people would find themselves lost in it. In a sense, it was a minimalist way of trying to handle the abuses that were taking place."
As for referring the question of cooperation to "reliable theological experts," Father Kopaczynski notes that in the general introduction to the Directives, the bishops say that "in the absence of a determination of the magisterium, but never contrary to Church teaching, the guidance of approved authors can offer appropriate guidance for ethical decision-making." Father Kopaczynski thinks that the "approved authors" perhaps refers to the "classical authors, those who have already gone home to the Father; whereas the ‘reliable theological experts’ might be those who are still among the living. That is open to some interpretation," Father Kopaczynski says. "Depending on who the experts are whom you consult, you might get a latitudinarian or a narrow interpretation of the document. You might want to say, ‘This theological expert is reliable to me’—but would he be reliable to somebody else?"
!l-250Father Kopaczynski thinks that the new Directive 70 should be the litmus test in judging the reliability of a theological expert. That directive states: "Catholic health organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide, and direct sterilization." The footnote to this directive cites the 1975 "Reply of the Sacred Congregation for the Doctrine of the Faith on Sterilization in Catholic Hospitals": "Any cooperation institutionally approved or tolerated in actions which are in themselves, that is, by their nature and condition, directed to a contraceptive end...is absolutely forbidden. For the official approbation of direct sterilization and, a fortiori, its management and execution in accord with hospital regulations, is a matter! which, in the objective order, is by its very nature [or intrinsically] evil."
In their "Statement on Cooperation, An Examination of the Fundamental Principles," the ethicists at the NCBC define immediate material cooperation as "any willful, intentional contribution to the circumstances essential to the principal agent’s immoral action, though that action may not be intended by the cooperator." If one applies this definition to Catholic health-care systems, even secular hospitals that remain secular after their purchase by a Catholic party may not offer abortion, euthanasia, assisted suicide, or direct sterilization.
An Uncertain Prognosis
Last year, when it became clear that the new directives would be more stringent on cooperation with sterilization, the CHA presented the bishops with a list of concerns expressed by Catholic health-care professionals. (Catholics for a Free Choice, on whose Web site this list appeared, claimed that CHA itself expressed these concerns. But Fred Caesar, CHA’s senior director for public affairs, said the list, though presented by CHA, did not express that organization’s concerns; rather, CHA "was reporting what had been expressed by Catholic health-care leaders in a meeting with the drafting committee of the National Conference of Catholic Bishops.")
!Among the concerns were the following: "The revision could result in another Humanae Vitae-type division within the church.... [It] will likely affect Catholic health care’s ability to approach potential partners [who] do not share our views on sterilization as an intrinsic evil.... There is a likelihood of the loss of OB/GYN services in many of our hospitals.... Some will see the proposed change as an attempt to impose our religious beliefs upon the community.... Women and children, especially the poor, will be most affected by these revisions.... The proposed revisions could jeopardize Catholic health care’s ability to carry on our mission by eliminating our presence in some areas, weakening our influence on moral issues, especially life issues.... Sponsors will be forced to consider whether or not to continue their health care ministry as Catholics, [and] the revisions may also create serious conflict !within religious congregations."
Insofar as this list of concerns reflects the attitude of Catholic health-care providers, there would seem to be little likelihood that they will obediently embrace the more stringent directives. One is left to ask how a Humanae Vitae-type division would be possible in a system where everyone followed Church teaching. Is the loss of OB/GYN services more serious than the sacrifice of Catholic principles? How will women be affected, except positively, by Catholic hospitals treating them according to their true human dignity? And how Catholic are the sponsors who will abandon their Catholicity because they are called to follow Church doctrine? The list of concerns presented by CHA may reflect an "unequal yoking"—not only of Catholic with non-Catholic institutions but of Catholics with anti-Catholic positions.
And of course, I'm going to offer my analysis.
The Catholic magisterium claims authority from God. They say that birth control, sterilization, sex not for procreation, and abortion are all abominations. They do not have the faintest idea what they are talking about because they are all me. If they ordained women and married men, I bet you they would reconsider their positions on birth control, sterilization, and sex not for procreation. I can respectfully disagree with them on abortion. But the cardinals will never have to be in the position of a hyopthetical woman in, say, Nicaragua. She has been pregnant ten times; this many pregnancies presents a health risk. She and her husband should engage in family planning, and should consider using contraceptives or getting sterilized. But wait, the cardinals think that's a sin!
I am glad for the Catholics involved in the healthcare system, who are much more thoughtful than their cardinals. They would rather continue providing services than following a bunch of old, mainly White men, who will never face the choices assiociated with sex and pregnancy. Some are probably pro-choice in their private lives, many are probably neutral, and many are probably pro-life but determined to let people choose for themselves.
Doctors who practice in Catholic hospitals must abide by their codes of conduct, which preclude abortion, sterilization, or, more recently, removing feeding tubes from comatose patients. This alone makes me a little uncomfortable. I am confident that social justice is a tradition that runs very deep within Catholicism. But I am not confident in the direction that the current pope is taking, and am concerned at how Catholic health systems could be affected.
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