Tuesday, March 6, 2012

The NCBC & Philadelphia's Catholic Hospitals

Most Rev. John J. McIntyre
Auxiliary Bishop of Philadelphia
John M. Haas, Ph.D., S.T.L., K.M., President
National Catholic Bioethics Center
Philadelphia, Pennsylvania

Your Excellency & Dr. Haas,

On February 11th, I attended the Pontifical Council for Healthcare Workers conference at St. Charles Borromeo Seminary. Though it was never stated, my impression was that the conference's audience was primarily drawn from employees of Catholic hospitals.

At one point, Dr. Haas asked members of the audience whether they were familiar with the ERDs. From my vantage point, it appeared that only half of them (to be generous) raised their hands. Personally, I was shocked when Dr. Haas responded with enthusiasm to this dismal showing! As per Directive # 5,

  • "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 for administration, medical and nursing staff, and other personnel."

If February 11th's audience were indeed employees of Catholic hospitals, the fact that only half of them even indicated familiarity with the ERDs strikes me as disgraceful and scandalous.

I have been deeply moved by Professor Leonard Nelson's Diagnosis Critical: The Urgent Threats Confronting Catholic Healthcare, as well as by Anne Carey's excellent pieces on Catholic Health Care in Our SundayVisitor:

In 2008's Shocking Lack of Understanding, Dr. Haas reported glaring misinterpretations of the ERDs and was quoted as calling for ethics audits of Catholic Hospitals: "Hospitals already have medical audits and financial audits, and they should have ethics audits, too." Yet in 2009's Catholic Physicians Encounter Multiple Challenges, Dr. George Isajiw still spoke of deeply troubling experiences - apparently at a Catholic hospital in our own archdiocese!

  • "I know Catholic ethicists who openly dissent from Church teaching on hydration and nutrition, and I've had experiences where I proposed an ordinary treatment for a patient, but the ethics committee at the Catholic hospital incorrectly advised the family that there was no moral requirement for the treatment. The family then changed doctors, and within days the patient was dead. From the family's standpoint, it's a burden to care for a loved one who is ill, so there is a temptation not to treat a very sick person. So when somebody in authority says it's OK to withhold ordinary treatment -- especially if a priest or nun says it's OK -- what more do they need to give into that temptation? That makes it difficult for me, a Catholic physician, to do things according to Catholic moral-medical teaching."

In the very recent and provocative Appeal to Conscience Clauses in the Face of Divergent Practices among Catholic Hospitals, Dr. Sandra Hapenney notes that "all [Catholic] hospitals assert [emphasis added] that they are abiding by the ERD" [sic]. Your Excellency & Dr. Haas - In the Archdiocese of Philadelphia, do our six Catholic hospitals undergo regular independent, rigorous audits of their compliance with the ERDs? If not, why not? Aren't the laity of the archdiocese entitled to know?

  1. Mercy Fitzgerald (part of the Mercy Health System & Catholic Health East)

  2. Mercy Philadelphia (part of the Mercy Health System & Catholic Health East)

  3. Mercy Suburban (part of the Mercy Health System & Catholic Health East)

  4. Nazareth (part of the Mercy Health System & Catholic Health East)

  5. St. Mary Medical Center (part of Catholic Health East)

  6. Holy Redeemer

In my opinion, Dr. Hapenney has provided some excellent thoughts on conducting ethics audits of Catholic hospitals, as well as the necessary follow-up:

  • "A best practices model would provide for the mandatory reporting of violations of the ERD to an independent review board with failure to report incidents leading to penalties or dismissal. Also, it would require the ethics committee of a hospital to be required to report all violations that come to their attention to an independent review board. The decisions of the ethics committee would also be mandatorily reviewed by an independent board. Another requirement would be that the hospital be required to report their patient diagnostic and procedure codes to an independent review board and ecclesial authorities on a periodic basis."

  • "Without oversight mechanisms in place, the lack of uniformity of practice among Catholic hospitals may pose a judicial risk to the hospitals if a legal challenge is made against a hospital to force the provision of sterilization procedures....Also at risk would be those individual health professionals who conscientiously object to involvement with procedures prohibited by the ERD when the Catholic hospital in which they practice allows those procedures."


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