Tuesday, December 30, 2014

"Question 87: How far may Catholic hospitals cooperate with providers of immoral services?‏" (Germain Grisez, The Way of the Lord Jesus, Volume III, 1997)

P.S. Your Excellency: Could any of our grandparents have imagined that - by the dawn of 2015 - it would be routine for Catholic hospitals to be overwhelmingly staffed by OBGYNs who are NOT NFP-only?  Could our grandparents have imagined that unsuspecting individuals could check Catholic hospital web sites for private contact info of providers of morally excluded services?  Back in 1997's The Way of the Lord Jesus, Vol III (which is available online in its entirety), Germain Grisez provided a fascinating reflection on "Catholic" hospitals and their prospects for remaining truly Catholic:
"to be an apostolate that carries on Jesus’ ministry of mercy, Catholic hospitals must not only deliver quality health care but provide service to 'the poorest and most abandoned of the sick,' give religious instruction and encouragement along with health care, explicitly evangelize, strive to humanize medical practice, fully conform to the Church’s moral teaching, and supply sound formation in that teaching. Of course, even isolated individuals’ work in the field of health care can qualify as a lay apostolate, in the same way as other morally acceptable occupations Christians might undertake, if carried out in a way that struggles against the evils that afflict such work and restores it in the light of the gospel, manifests Christian mercy, and bears clear witness to faith (see AA 5–7; LCL, 102–13). However, Catholic hospitals will have lost their identity unless they meet all the conditions for carrying on Jesus’ mission of mercy 275....

"doing God’s will and entirely avoiding wrongdoing are at the heart of anything that can be called an apostolate. Do not regard actions such as sterilization and abortion merely as forbidden procedures and do not think of wrongful cooperation with them merely as rule breaking, to be avoided if possible. Recognize such acts as grave injuries to persons or their very destruction, and thus contrary to Christian love and entirely incompatible with your apostolate....

"If a Catholic hospital is to carry on its work as an apostolate, its board members and administrators should deal with formal cooperation in various evils by its personnel. If those responsible instead studiously avoid noticing such formal cooperation or decide to tolerate it, they at least materially cooperate in it in a way that hardly can be justified. As a community committed to an apostolate, the hospital will have betrayed itself even if its board members and administrators manage to stop just short of letting its own complicity in evil become formal cooperation.

"Material cooperation with wrongdoing can be scandalous in the strict sense: It can lead people to sin by encouraging them in rationalization and self-deception (which do not free them of guilt) regarding the wrongdoing. The scandal would not be prevented by a Catholic institution’s prohibition of morally unacceptable procedures within the domain remaining to it, even if that policy is well publicized. For to most non-Catholics and many Catholics the material cooperation would seem to imply that those procedures are not wrong in themselves but merely forbidden to Catholics, as eating meat on Friday used to be. Moreover, other things being equal, a Catholic institution’s material cooperation is much more likely to be scandalous than an individual Catholic’s. The institution’s acts are presumed to be fully deliberate and free, not the product of ignorance or weakness, as an individual’s might be. And since the institution claims to be distinguished from others by being Catholic, whatever it does is taken by many non-Catholics and even unsophisticated Catholics to be the Church’s own act.

"In various ways, a Catholic institution’s significant, obvious, voluntary cooperation in wrongdoing inevitably will impair and probably even negate its capacity to provide credible witness. For example, commingled with the service of secularized providers, its activities will become less identifiable and less distinctively Catholic. Again, the closer association with health care providers whose practice violates moral norms taught by the Church often will make it harder for a Catholic institution’s administrators and staff to speak out for the truth of those norms and work against their violation....For those engaged in health care as an apostolate to impair their witness in these and other ways would be utterly self-defeating, since, to repeat, the essence of apostolate is not only to promote a human good such as health but to practice Christian love and bear witness to the gospel’s truth, including love for the tiniest and the most debilitated of Jesus’ sisters and brothers, and the moral truths regarding how they are to be dealt with."

Friday, December 26, 2014

On this eve of the Feast of the Holy Innocents....

Your Excellency:

It has been reported that a Catholic pediatrician is suing the City of Philadelphia, alleging that she was fired for refusing to write prescriptions for "contraceptives" (cf, Philadelphia Magazine, 10/10/14).  What strikes me as most tragic is that faithful health care professionals in secular settings can expect minimal recognition of the right to conscientious objection, if prohibited practices receive a "wink and a nod" on "Catholic" turf.  As per Professor Leonard J. Nelson, III,
  • "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). 
While there is an absolute need to properly understand and interpret the USCCB's Ethical and Religious Directives for Catholic Health Care Services, isn’t it possible that some would simply prefer to be ignorant of a proper understanding and interpretation?  With reimbursement for top people at Catholic hospitals in the hundreds of thousands of dollars, [i] such ignorance could be seductively comfortable!  Why rock the boat?  As per the character Che in Evita, “When the money keeps rolling in, you don't ask how.

In 2014, I believe that Catholic hospitals in the Archdiocese of Philadelphia continued to foster scandal, through cavalier and continued cooperation with providers of morally excluded services[ii].  What possible sense does it make for hospitals to be associated with physicians who prescribe substances (e.g., hormonal contraceptives), which are potentially fatal to babies and women?  And why would any parish allow advertising for a pharmacy that sells hormonal contraceptives[iii]?  

In February, the Congregation for the Doctrine of the Faith provided "Some Principles for Collaboration with Non-Catholic Entities in the Provision of Health Care Services", reminding everyone of the need to prevent "a diminution of the prophetic witness to the Faith" and scandal and offering 17 specific principles.  Those specific principles would lessen the chance for improper understandings and interpretations of the ERDs. [iv]  From their recently concluded meeting, we have been told that
The bishops also voted 213-2-1 in favor of pursuing a revision of Part Six of the ‘Ethical and Religious Directives for Catholic Health care Services’ to incorporate guidance the USCCB received from the Vatican’s Congregation for the Doctrine of the Faith last February. This action item was presented by the USCCB Committee on Doctrine. 

Particularly as the Archdiocese is home to Catholic Health East which has “regional healthcare systems in 11 eastern states from Maine to Florida,” the Archdiocese can hardly seem to wait for the entire USCCB to act.  Please immediately remind Catholic Health East and all hospitals in the Archdiocese of the need to adhere to the Vatican’s Principles.

Thank you.


[i]  If ignorance helps maintain astronomical levels of financial compensation, it pays handsomely to be ignorant of Catholic medical ethics!
Holy Redeemer: The president/ceo recently had $767, 949 in total compensation (http://pdfs.citizenaudit.org/2013_05_EO/23-1534300_990_201206.pdf).

Catholic Health East: For 2012, the president/ceo had $3,890,553 in "reportable compensation from the organization," as well as $17,510 in "estimated...other compensation from the organization and related organizations" (http://www.che.org/about/pdf/2012CHE99signed_filed.pdf).
St Mary Medical Center: For 2012, the CEO had $705,458 in "reportable compensation from related organizations," as well as $39,905 in "estimated...other compensation from the organization and related organizations" (http://www.che.org/about/pdf/2012CHE99signed_filed.pdf).

Mercy Health Systems of SE Pennsylvania: For 2012, the CEO had $401,992 in "reportable compensation from related organizations," as well as $29,859 in "estimated...other compensation from the organization and related organizations" (http://www.che.org/about/pdf/2012CHE99signed_filed.pdf).

[ii] 1) Holy Redeemer
An archdiocesan priest is the face of "ethics" at Holy Redeemer.  While Holy Redeemer's physician directory includes only one OB/GYN who can be found on an NFP-only list, 20 others cannot be found! 
At Reproductive Medicine Associates of Philadelphia (RMA)  and Abington Reproductive Medicine (ARM), people can choose from a smorgasbord of morally excluded services, such as egg/embryo/sperm "donation," IVF, and "surrogacy."  Yet, Holy Redeemer's physician directory includes seven physicans (i.e., 1, 2, 3, 4, 5, 6, 7) from RMA and ARM!  When people obtain contact information for the seven physicians from a Catholic hospital with a priest ethicist, how are they to understand the immorality of such services?
  •  As acknowledged by the U.S. Department of Health and Human Services, "Assisted Reproductive Technologies (ART)....primarily includes the technique of in vitro fertilization (IVF)....ART alone now accounts for 1.5 percent of all births in the United States."
  • For 2013, the Pa Dept of Health reports a total of 47,546 births in Bucks (4,916), Chester (5,395), Delaware (6,527), Montgomery (8,690), and Philadelphia (22,018) Counties.  While an inadequate demographic tool, 713 (1.5%) would be a good guess of how many of those 47,546 births in the Archdiocese were associated with ART/IVF. 
  • According to the U.S. Centers for Disease Control and Prevention, Applying the 1.7% rate (Yes, I realize that demographers would have a field day with that being an inadequate technique) would lead to a guess of 854 IVF births in the 5 counties of the archdiocese in 2013. With about 30 embryos created for those 713 successful births, it can be estimated that 21,390 embryos were created in the Archdiocese “with many lost, discarded or destroyed by research. Some…lives are still on ice waiting for a chance to finish their lives. Many will die waiting” (cf, LifeNews.com, 7/25/12).
In addition, Holy Redeemer's Advance Directive form fails to clearly specify:
·         Catholic teaching with regard to nutrition and hydration, and
·         that health care services cannot honor non-specific directives to forego nutrition and hydration.
2) St. Mary Medical Center (Catholic Health East)
While St Mary's directory includes one OB/GYN who can be found on an NFP-only list, 27 others cannot be found on that list.  While Drs. Richard Latta, Marc Rosenn, and Stephen Smith are on the list, each is from Abington Perinatal Associates - a practice reported to be involved with fetal "reduction" – a euphemism for abortion (See # 1, # 2, and # 3.).  In addition, Saint Mary's Advanced Directives and Living Wills fails to clearly specify:
·         Catholic teaching with regard to nutrition and hydration, and
·         that health care services cannot honor non-specific directives to forego nutrition and hydration.
3) Mercy Fitzgerald, 4) Mercy Philadelphia, 5) Mercy Suburban, 6) Nazareth (Catholic Health East/Mercy Health Systems of SE Pennsylvania)
·          There is No OBGYN in the Mercy Health System of Southeast Pennsylvania, who can be identified on One More Soul's list of NFP only OBGYNs.

[iii] For example, the parish bulletin for St. Charles in Bensalem.  

[iv] CDF Principles for Collaboration with Non-Catholic Health Care Entities: Ministry Perspectives” (CHAUSA, 2014) highlights the USCCB’s needs to step up to the plate, to prevent "a diminution of the prophetic witness" and scandal:
·          Peter Cataldo, Ph.d. of the Archdiocese of Boston says  “The CDF’s Principles…confirms recent interpretation and application of the Principle of Cooperation to Catholic/otherthan-Catholic health care collaborations.”  Business as usual?
·          Carl Middleton, Jr., D. Min. of Catholic Health Initiatives also seems to see a confirmation of the status quo: “the CDF’s Principles seem to be principles that have generally guided transactions between Catholic and other-than-Catholic health care entities.”
·          John. A. Gallagher, Ph.D., thinks the whole topic is  none of the Vatican’s business!  He says that the 17 principles “are new, they are innovations, and, like any innovation in Church teaching, they need to be treated with a high degree of skepticism until their link to the authentic magisterium can be verified. But the mystery remains, from where did these principles come? Is it possible that ‘the voice is that of Jacob, but the arms are those of Esau?’….[What is being addressed is]a uniquely American issue. It is an important and more than valid question. But it needs to be discussed, debated and resolved by American theologians, representatives of the Catholic health care systems and members of the American hierarchy. Such a conversation needs to begin with the question the bishops posed to the Congregation, not with the 17 principles.”  Wow!  Who pays his salary?
·          It is refreshing that Father Michael D. Place, S.T.D. at least recognizes that the 17 principles are relevant to so-called “‘carve outs’….entities that provide illicit services outside of the Catholic institution”
·          Steven J. Squires, MA, MEd, Ph.D. of Catholic Health Partners, sees this as  “an opportunity to reflect upon, dialogue, and discuss the Principles and the PoC, not only with our bishops and their advisors, but also within our organizations, especially with our leadership and boards.”  Is it an opportunity to disseminate guidance and adhere to that guidance?

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