Religious Hospitals, Secular Hospitals, and Democratic Process

A fascinating hospital purchase drama with medieval undertones is unfolding in Wheat Ridge, Colorado.

The Sisters of Charity of Leavenworth Health Systems is seeking to purchase Exempla Lutheran Medical Center. If the Attorney General approves the transfer of ownership, procedures prohibited under Catholic health care rules – such as abortion and tubal ligation – will no longer be permitted at Lutheran. A group of Lutheran doctors, supported by the ACLU, Planned Parenthood, NARAL, and other organizations, are lobbying against the sale.

The contending parties have rich histories. The Sisters of Charity opened the first private hospital in Kansas in 1864. Lutheran was founded in 1905 as a tent colony for tuberculosis patients. Both entities are mission-driven and committed to care of the poor.

The issue of merger between secular and religious hospitals is common enough to be the single focus of an activist organization, MergerWatch. The secular/religious conflict in Colorado is a vintage good vs good ethical dilemma. Catholic health care has a noble history of devotion to the poor and vulnerable. But in our pluralistic society, many do not share Catholic views on reproductive ethics. Lutheran, with its own noble history, has provided these services to its community.

Two days ago the Rocky Mountain News carried a moving plea for compromise from Dr. Lawrence Rust, a retired trauma surgeon who had practiced at Lutheran. Dr. Rust seeks a path whereby “both sides of this dispute can salvage their most important principles.” Specifically “the medical staff at Lutheran needs assurance that they will be free to practice on a daily basis without interference,” and “the Sisters of Charity need to know that the organization that they own faithfully represents their core values.”

I am committed to deliberative discussion as a key process for ethical governance of the health system. I would sorely love to believe Dr. Rust’s proposal could work:

“When a physician disagrees with a policy, the disagreement would be handled openly by peers. The Catholic voice would be joined with other professional voices in committees, and the resulting decisions would be forged from reason and discussion. If the decision disagreed with the Catholic approach (such as allowing tubal ligations) both sides would have had the opportunity to fully present their side, but the consensus approach would prevail.”

Unfortunately, this won't work. The Catholic perspective on reproductive services does not arise from particular facts about individual situations. The Conference of Bishops "Ethical and Religious Directives for Catholic Health Services" prohibit abortion and sterilization under all circumstances. If the Directives are to be followed the hope that "decisions would be forged from reason and discussion" is, alas, entirely quixotic.

Hospitals drop "service lines" all the time, especially if the service in question is a money loser. In Wheat Ridge the issue is principle, not money. It is hard to see how the Sisters of Charity could respect pluralism and allow the prohibited procedures to be done, say, by a nominally independent portion of the hospital. Apart from logistical complexities, the Bishops are clear: "Catholic health institutions are not to provide abortion services, even based upon the principle of material cooperation."

So what should be done? If I were the Sisters of Charity I would not want to be seen as imposing my moral perspective -- even though I fervently believed it was absolute truth -- on those who did not share it. But that is exactly how buying Lutheran and dropping the forbidden services would appear. But if I were a physician at Lutheran I would want to be sure that I was protesting because the purchase would make the services significantly less available to those who want them, and not because, like Martin Luther himself, I was opposing "Catholic power" on principle.

The decision is in the lap of the Attorney General. In my view, if the purchase would significantly reduce access to services that are legal and, by a majority of the population, seen as ethically acceptable as well, I would not allow it to go through. But if I concluded that the services were readily available I would allow it to go ahead.

Pluralism does not come easily. We need to learn all we can about how to respect principles and pluralism from cases like Wheat Ridge. I hope to be able to follow the story, and invite readers to comment.