An expert on health care law, Professor Leonard J. Nelson, III, provides an eye opening, disturbing account in "
Diagnosis Critical: The Urgent Threats Confronting Catholic Healthcare." This work is divided into six parts (i.e., "Moral Foundations," "Catholic Identity," "The Struggle to Maintain Catholic Identity as Reflected in Two Health Care Systems," "Catholic Health Care and the Right of Conscientious Objection," "End-of-Life Care," "Social Justice and Health Care Reform") & a Conclusion. Professor Nelson's 229 pages of eye-opening text are readable and enthralling (He also provides 113 pages of end notes.). In his introduction, he warns that "Catholics may have to focus their future efforts on the creation of alternatives to acute care hospitals such as free clinics, specialized centers for reproductive medicine, and hospices for end-of-life care that could reinvigorate health care ministry" (p. 19).
MORAL FOUNDATIONS: Within chapters on "The Catholic Natural Law Tradition," "Challenges to the Catholic Natural Law Tradition," "The Reassertion of Absolute Norms" and "Secular Bioethics versus Catholic Bioethics," Professor Nelson undertakes an ambitious history and survey of contemporary Natural Law adherents, dissenters, and acknowledged opponents. At times, he may inadvertently lend a veneer of legitimacy to dissenters, by using the term "revisionist." A more direct challenge to those who engage in sophistry to mislead Catholics into thinking that some teachings of the Magisterium are not binding (cf., # 2034 & #832 of the
Catechism of the Catholic Church) would have also been appreciated. He does certainly acknowledge that "In terms of its practical effect, the widespread prevalence of dissent among both religious and lay Catholics may make it more difficult for Catholic health care institutions to persuade policymakers that they should be exempt from laws of general application requiring the provision of sterilizations and abortions. And, of course, the situation of Catholic health care institutions has become even more problematic since it has become commonplace for high-profile Catholic politicians to be openly and avowedly `pro-choice'" (p. 32).
The chapter on "Ethical and Religious Directives" provides a fascinating history of the U.S. Bishops'
ERDs and an often disturbing look at how they have been received: "compliance with the ERDs has been uneven when it comes to contraception and sterilization. Typically, obstetrician-gynecologists practicing in Catholic hospitals and physician office buildings owned by Catholic hospitals provide prescriptions for contraceptives to their patients" (p. 53). Kudos go to Professor Nelson, when he straightforwardly challenges the disregarding of Catholic medical ethics:
- Professor Nelson reminds us that "the bishop is responsible for monitoring compliance with the ERDs in his diocese" (p.55).
- "By 2003, at least two Catholic hospital systems were performing early induction of labor...where the baby had a condition that would significantly shorten its life....it seems clear that these policies are not morally licit under Directives 48 and 49 of the 2001 ERDs" (p. 77).
I believe that Professor Nelson's treatment of several other topics should have been similarly straightforward:
- So called "Emergency Contraception" is discussed in Chapter 5 & 12. It has elsewhere been reported that "Catholic hospitals in several dioceses in North America are currently administering the pill (Plan B) to patients who claim to be victims of rape....The only Vatican opinion on the subject, absolutely prohibiting the use of the pill, was released by the Pontifical Academy for Life in 2000. Since then, however, the Catholic Health Association, advisor to many bishops conferences, has suggested that there is no moral impediment to using the pill in cases of rape....LifeSiteNews.com asked Bishop Sgreccia if there was an exception in cases of rape. The [then] President of the Pontifical Academy for Life replied, `No. It is not able to prevent the rape. But it is able to eliminate the embryo. It is thus the second negative intervention on the woman (the first being the rape itself)'" (LifeSiteNews.com, 2/29/08). Section 23 of the Vatican's 12/08 Dignitas Personae offers no guidelines for the supposed "moral" use of Plan B (aka, the "morning-after pill", so-called emergency "contraception"). It reminds us that so-called contraceptives are "interceptive if they interfere with the embryo before implantation and contragestative if they cause the elimination of the embryo once implanted...the use of means of interception and contragestation fall within the sin of abortion and are gravely immoral." This appears to require change at Catholic hospitals, regarding the treatment of individuals who identify themselves as victims of sexual assault.
- Father Tad Pacholczyk, Ph.D.'s of the National Catholic Bioethics Center has discussed the treatment of ectopic pregnancies ("When Pregnancy Goes Awry," 10/09). Citing the principle of "double effect," Catholic health care has allowed the removal of a fallopian tube to save a mother's life, in the case of an ectopic pregnancy. This unintentionally and indirectly results in the death of the preborn child. Yet, Father Tad further explains that "A significant number of Catholic moralists hold that the use of methotrexate is not morally permissible because it constitutes a direct attack on the growing child in the tube and involves a form of direct abortion. Another morally problematic technique [i.e., salpingostomy] involves cutting along the length of the fallopian tube where the child is embedded and 'scooping out' the living body of the child, who dies shortly thereafter." It is troubling to find that a 1998 article by Father Kevin O'Rourke remains on the web site of the Catholic Health Association of the USA, in which Father O'Rourke appears to suggest that salpingostomies and methothrexate ARE acceptable treatments.
CATHOLIC IDENTITY: The title of Chapter 6 speaks for itself: "Transformation of the Catholic Hospital from Religious Ministry to Business Enterprise." I believe that a good number of Catholics would be absolutely shocked to know that "Occasionally, in order to reduce opposition to a merger or affiliation, Catholic hospitals have entered into arrangements to allow continuation of services such as surgical sterilizations in separate facilities to be provided by unrelated organizations" (p. 88). Chapter 7 takes a look at "Catholic Hospitals and Canon Law."
THE STRUGGLE TO MAINTAIN CATHOLIC IDENTITY AS REFLECTED IN TWO HEALTH CARE SYSTEMS: While some Catholic health "systems have entered into arrangements to provide services such as direct sterilizations and abortion referrals....The existence of such arrangements increases the risk of scandal and could embolden those who favor a mandate requiring all hospitals...to provide a full range of [so-called] reproductive services" (p. 102).
CATHOLIC HEALTH CARE AND THE RIGHT OF CONSCIENTIOUS OBJECTION: As per Professor Nelson, "If legal protection for individual conscience erodes, then this also endangers legal protection for institutions that refuse to perform sterilizations and abortions....any argument in favor of exemption from laws requiring a hospital to provide these services may be substantially undermined by the fact that the Catholic hospital is already, in some fashion, involved in either providing those services - as in the case of sterilizations - or involved in partnerships with entities providing such services" (pp. 132, 137).
END-OF-LIFE CARE: I found myself wishing that Professor Nelson's treatment of this topics was also more straightforward; however he finishes strongly:
- In its introduction to End-of-Life directives, the 2001 ERDs state that "The USCCB Committee on Pro-Life Activities' report...points out the necessary distinctions between questions already resolved by the magisterium and those requiring further reflection, as, for example, the morality of withdrawing medically assisted hydration and nutrition from a person who is in the condition that is recognized by physicians as the `persistent vegetative state' (PVS)." Since 2001, the Vatican has addressed this very matter on at least two occasions....
- As per a 3/2/04 address by Pope John Paul II, "I should like particularly to underline how the administration of water & food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary & proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering."
- As per the Vatican's 2007 Responses to Certain Questions Concerning Artificial Nutrition and Hydration, "The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.... A patient in a `permanent vegetative state' is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means."
In response to those who would suggest otherwise, Professor Nelson is to be credited for stating that: "it would seem that the same provisions for continuation of ANH should apply to persons who are actually conscious, although with diminished abilities, as would apply to those who appear to be permanently unconscious with no higher brain activity" (p. 195).
SOCIAL JUSTICE AND HEALTH CARE REFORM: Unfortunately, Professor Nelson appears to allow the term "Social Justice" in a common but inadequate manner. In this regard, the Holy Father provided a remedial lesson to
U.S. Ambassador Miguel Diaz: "The Church insists on the unbreakable link between an ethics of life and every other aspect of social ethics, for she is convinced that, in the prophetic words of the late Pope John Paul II, 'a society lacks solid foundations when, on the one hand, it asserts values such as the dignity of the person, justice and peace, but then, on the other hand, radically acts to the contrary by allowing or tolerating a variety of ways in which human life is devalued and violated, especially where it is weak or marginalized' (Evangelium Vitae, 93; cf. Caritas in Veritate, 15)." Recognition of the sanctity of human life is at the very core of authentic Catholic Social Teaching."
I was disappointed that Professor Nelson did not elaborate, with regard to the Catholic Medical Association's recommendation of "`experiments with diocesan self insurance' to avoid paying for contraceptive coverage and to strengthen support for natural family planning" (p. 219).
CONCLUSION: Professor Nelson echoes his words from the Introduction, which now seem more prophetic: "Catholics may have to focus their future efforts on the creation of alternatives to acute care hospitals such as free clinics, specialized centers for reproductive medicine, and hospices for end-of-life care that could reinvigorate health care ministry" (p. 19).
