Wednesday, July 18, 2012

"Catholic" - A Health Care "Brand" We Can Trust?

Yesterday's mailing from the Pennsylvania Pro Life Federation / Philly Pro Life was gushing in its support of a widely reported hospital merger in our area:
    "By now many of you have heard of the great news that Holy Redeemer and Abington Memorial hospital are merging and as such Abington will stop performing abortions, but what you may have not heard is that there is a strong force trying to stop this from happening. The pro-abortion community is against this merger and is doing everything in its power to stop it. Many community leaders have gotten together and started a petition in protest. So far they have collected over 1200 signatures and are on a mission to get more.
    "This is OUR TIME to do something! Click on the following link and LEAVE A COMMENT in support of Abington's decision to stop doing abortions!!! It only took me 1 minute to do! Do it now and spread the word. Put it on Facebook, Twitter, text it, email it. If you have a web-site post this link. If you prefer call Abington at 215-481-2000. Do whatever you have to do to increase our numbers. This is the reason you read this newsletter. This is the reason why you stand for life. You can literally save lives by clicking and leaving a comment." 
Unfortunately, the notion that Holy Redeemer is going to have a genuine "pro life" influence on Abington strikes me as wishful thinking (Tragically, the reverse may be true.).  Getting lost in this conversation is a Catholic understanding of "cooperation" and a realistic appraisal of Holy Redeemer's current embrace of pro life and Catholic medical ethics.

Ralph and Norton

Imagine that Norton wakes up on a Saturday morning to the sound of his phone ringing.  On the other end is his BFF Ralph, whom Norton knows to have recently lost his job with the bus company.  Ralph explains that he has found the "answer" to his money problems, in that he's going to rob the "Fifty-Second National Bank."  He's asking Norton to drive the getaway car.  What are Norton's possible reactions?
  • "Ralphie Boy, that's inexcusable, and I care too much to let you do something so wrong."  Now, not getting too technical, that sure strikes me as an example of "Love."
  • "Hey Ralphie, times are tough, and so are you.  You've made a difficult decision for yourself and Alice.  Trixie and I are with you, Big Guy.  Let me grab a coffee, and I'll start up the car."  That is an example of "Formal Cooperation."
  • "Ralphie Boy, times are tough, but that's a wrong and terrible idea.  On the other hand, I don't want to lose our friendship.  Let me grab a coffee, and I'll start up the car." That is an example of "Material Cooperation."  Norton says he's opposed to Ralph's wrongful act, but he's still providing assistance.  In fact, Norton's assistance is "immediate," as opposed to "mediate."  Ralph is relying on Norton's immediate material cooperation, to commit his wrongful act. 

Lucy and Ethel

That very same Saturday morning, Lucy asks Ethel to drive her to Ricky's club, where she stores and maufactures veta vita vegamin.  On the way, Ethel learns for the first time that Lucy has undercut her competition by employing unsafe, dangerous, unethical practices in manufacturing veta vita vegamin.  While Ethel implores Lucy to do the right thing and correct her practices, she stops short of insisting that Lucy get out of the car.  In any case, Lucy does not need Ethel to drive a getaway car (i.e., The subway is just as handy as Ethel's car.).  While Ethel is providing some material cooperation to Lucy's unethical manufacture of veta vita vegamin (in that she's driving Lucy to the site of her wrongful acts), her material cooperation could probably be described as "mediate" rather than "immediate."

"Cooperation in Evil"

When is it OK - if ever - for Norton to drive Ralph or Ethel to drive Lucy?  When is it OK - if ever - for physicians - particularly in the areas of obstetrics and gynecology - to have "privileges" in a Catholic hospital, when those physicians are not NFP-only physicians?  When is it OK - if ever - for Catholic hospitals to actually list these same physicians in directories, without warning patients that these physicians are known to NOT embrace Catholic medical ethics?  When is it OK for bishops to seemingly ignore the concerns of their people on these matters? 

In a 2005 communication, the Vatican's Pontifical Academy for Life recalled "the principles assumed in classical moral doctrine with regard to the problem of cooperation in evil....
    "The first fundamental distinction to be made is that between formal and material cooperation. Formal cooperation is carried out when the moral agent cooperates with the immoral action of another person, sharing in the latter's evil intention. On the other hand, when a moral agent cooperates with the immoral action of another person, without sharing his/her evil intention, it is a case of material cooperation.
    "Material cooperation can be further divided into categories of immediate (direct) and mediate (indirect), depending on whether the cooperation is in the execution of the sinful action per se, or whether the agent acts by fulfilling the conditions - either by providing instruments or products - which make it possible to commit the immoral act. Furthermore, forms of proximate cooperation and remote cooperation can be distinguished, in relation to the 'distance' (be it in terms of temporal space or material connection) between the act of cooperation and the sinful act committed by someone else. Immediate material cooperation is always proximate, while mediate material cooperation can be either proximate or remote.
    "Formal cooperation is always morally illicit because it represents a form of direct and intentional participation in the sinful action of another person. Material cooperation can sometimes be illicit (depending on the conditions of the 'double effect' or 'indirect voluntary"'action), but when immediate material cooperation concerns grave attacks on human life, it is always to be considered illicit, given the precious nature of the value in question.
    "A further distinction made in classical morality is that between active (or positive) cooperation in evil and passive (or negative) cooperation in evil, the former referring to the performance of an act of cooperation in a sinful action that is carried out by another person, while the latter refers to the omission of an act of denunciation or impediment of a sinful action carried out by another person, insomuch as there was a moral duty to do that which was omitted. Passive cooperation can also be formal or material, immediate or mediate, proximate or remote. Obviously, every type of formal passive cooperation is to be considered illicit, but even passive material cooperation should generally be avoided"
On its "Find a Physician" page, Holy Redeemer states that
  • "As a Catholic healthcare provider, Holy Redeemer expects that all health care practitioners adhere to the Ethical and Religious Directives for Catholic Health Care Services at health system locations. We are committed to maintaining the highest professional standards while promoting our commitment to human dignity and the common good" (It then provides a link to the United States Conference of Catholic Bishops.).
Of Holy Redeemer physicians listed for
  • Gynecologic Oncology (Hanjani, Parviz M.D.),
  • Gynecology (Ranucci, Denise M.D; Gueson, Emerita T M.D.; Deeney, John J M.D.; Hagan, Eugene P M.D.; Thornton, R. Scott M.D; Matteo, Anthony J M.D.), and
  • Obstetrics and Gynecology (Borthwick-Scelzi, Laura M.D.; Ameri, Vahideh T M.D.; Hammond, Meggy D.O.; Ntoso, May-Ange M.D.; Dougherty, Regina D.O.; Torres, Anabis M.D.; Ruberu, Monique M.D.; Kessler, Stephen M.D.; Sock, Jennifer D. M.D.; Maniar, Gayatri M.D.; Dershaw, Stuart Z M.D.; Belder, Lev D.O.; Emami, Kavous M.D.; Klebanoff, David M.D.; Stack, John M Jr M.D.; Starikov, Albert D.O.; Becher, Patrick J D.O.; Kramer, Joel R D.O.; Rubin, S. Bruce M.D.; Binder, David M.D.),
I have found NONE of the above named in an NFP-only physician directory.  A little bit of googling, however, reveals that there are among these physicians practitioners of IVF  and third-party reproduction.  Doesn't it strain credibility to believe that physicians - whose philosophies are polar opposites to Catholic health care ethics - are simply able to embrace Catholic ethics, when they are at Holy Redeemer?  Our Lord told us to be "shrewd as serpents and simple as doves" (Matthew 10: 16).  He did not counsel us to be gullible.  At an absolute minimum, why aren't Catholic hospitals and the Archdiocese providing "product warnings" about these physicians in Catholic hospitals?  

Ethical and Religious Directives for Catholic Health Care Services (ERDs)

While distinctions regarding "cooperation" MIGHT be a LITTLE confusing for Norton, Ed, Lucy, and Ethel, they shouldn't present great difficulty for professionals in Catholic health care, especially if those professionals are receptive to the Church's moral guidance.  Yet, we must recognize that there has been a history of Catholic hospitals misinterpreting and misapplying "cooperation."  In 1995, the Catholic Bishops of the United States issued the third edition of the Ethical and Religious Directives for Catholic Health Care Services, which contained an appendix discussing "cooperation" (Note: The full text of the appendix can be found here.).  Subsequent to that third edition, the USCCB acknowledged that the appendix had indeed been insufficient in precluding misinterpretations and misapplications (Without offering distinctions in types of cooperation, the USCCB now indicates that "as a rule, Catholic partners should avoid entering into partnerships that would involve them in cooperation with the wrongdoing of other providers" (4th edition, 2001; 5th edition, 2009).). 

"Catholic" - A Health Care "Brand" We Can Trust?

As per Catholic journalist Ann Carey, "Nancy Valko, a registered nurse and president of Missouri Nurses for Life, and a spokeswoman for the National Association of Pro-Life Nurses, added that Catholic hospitals should seize the opportunity to 'brand themselves' as being places where patients can feel comfortable knowing that all treatments are ethical" (Many hospital ethics boards out of touch with Church, Our Sunday Visitor, 2/6/11).

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About Me

I am an enormously blessed husband and dad. In regard to my Catholic theological background, I have a certificate in social ministry & a master's degree (moral theology concentration), as well as a catechetical diploma from the Vatican's Sacred Congregation for the Clergy (Nope, I am not now - nor have I have ever been - a seminarian, deacon, or priest.). I feel particularly proud to have a mandatum. I also have a doctorate in Christian counseling psychology.

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12/12/08 Interview with Rev. Tad Pacholczyk, Ph.D. of the National Catholic Bioethics Center

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