In January 2018, the federal Department of Health and Human Services (HHS) announced its decision to offer support to medical professionals who decline to provide care – primarily abortion- and transgender-related healthcare – because of their personal beliefs. These beliefs don’t have to be written down anywhere, don’t have to be part of an organized religion or group, and don’t even have to be beliefs that anyone else holds. The person just has to say, “This goes against my conscience,” and the newly-empowered HHS Office of Civil Rights will get to work on finding ways to help them defend that belief by denying care.

This opens a valley-sized doorway to denial of care. This isn’t religious freedom: it’s a taxpayer-funded tool that will allow caregivers to hurt people who might depend on them.

While this might sound like a huge change or an affront to the Hippocratic Oath, belief-motivated denial of care isn’t a new concept in American health care. In fact, since 2010, more and more women have been reporting that they were denied abortion care or tubal ligation (having your “tubes tied” to ensure sterility), even in cases of emergency, right from their hospital bed.

Tamesha Means sits in a living room with two other people, one of them a young boy. Family photos crowd two large frames on the wall above them.
Tamesha Means suffered a miscarriage at 18 weeks; the miscarriage, a painful and traumatic experience, lasted days. Rather than offer abortion care that could have saved Tamesha from untold suffering, her Catholic hospital sent her home with Tylenol three times. Image: ACLU.

The reason behind the denials is simple: these women are in Catholic hospitals that follow the Catholic Directives, a series of rules laid out by bishops that specify what Catholic hospitals can and cannot do. In 2016, one in six hospital beds in the United States was in a hospital bound to the Catholic Directives; in California, it’s almost precisely that percentage, with the Directives covering 15.9% of all beds. It gets worse when you talk about health-related emergencies: Catholic hospitals control at least 40% of all acute care beds in five states. Ten of the nation’s 25 largest health system are Catholic-owned. And the situation only grows worse every time a Directives-bound organization buys up another hospital or health system. If you weren’t aware of any of this, you’re not alone: you can blame the fragmented and opaque structure of the American health care system for the largely unnoticed proliferation of Catholic hospitals.

On the ground, this translates directly into a significant reduction in the number of reproductive care procedures women receive. There are health systems in the country where women, particularly those in rural areas, don’t have access to a hospital that will care for their reproductive needs. This impacts their lives in countless ways.

Crucially, these hospitals also refuse to train new doctors in how to perform abortion, which is a very safe and relatively straightforward procedure for someone with the right expertise to perform. In Texas, for example, there are barely any clinics or universities left that offer courses in abortion. Volunteer groups like Medical Students for Change are doing what they can to train practitioners and keep this knowledge alive, but they face incredible challenges in their work. 

We’re going to see more and more of this, too, as HHS gets more familiar with its new powers.

This situation has led to devastating consequences for women seeking care. This report from the American Civil Liberties Union (ACLU) details case after case where women were subjected to painful and traumatic miscarriages, some of them lasting days, which would have been alleviated by abortion care in any non-Catholic hospital. There are cases where women who have reached their ideal family size, or who need to avoid pregnancy for medical reasons, were denied sterility procedures. Weaving throughout the stories are statements from doctors and nurses who wanted to provide the best care for their patients, including abortion care, but who were kept from doing so by hospital administrators.

A close-up of Mindy Swank sitting in a family room.
Mindy Swank was thrilled to discover she was pregnant a second time; she was devastated when she miscarried, and sought medical help when her body couldn’t complete the process. Her Catholic hospital refused to perform an abortion despite multiple hemorrhages and undeniable proof that Mindy’s baby wouldn’t survive. They finally induced labor at 27 weeks, when Mindy was hemorrhaging severely and after she had endured weeks carrying a baby she knew couldn’t live. Her baby died a few hours after delivery. Image: The Journal-Register.

This isn’t how health care should operate. Patients have the right to determine what happens to their body, and they have a right to have that spectrum of care include procedures and medicines that are safe and readily available, without having some options foreclosed because the practitioner objects to them. The ACLU and others have struggled to prosecute cases around denial of care based on religion or morality for numerous reasons, including the complexity and narrowness of medical malpractice law.

As with all things, the best way to remedy this situation is to elect lawmakers and local officials who will stand up for their constituents’ right to access health care with no strings attached. We hope you’ll join us in 2018 as we put in the work that will lead to a future where this ridiculous, discriminatory, and potentially life-threatening rule is completely rescinded, and Catholic hospitals are required to provide a complete spectrum of care to their patients.

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