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Apr 07 2014

Firmly prohibited in Catholic hospitals

This again. The Savita Halappanavar scenario, in the US, in a Catholic hospital. It happens a lot but it seldom gets reported on. This one got reported on because the woman is a nurse. Most women this happens to aren’t nurses or doctors.

Jennifer had been experiencing heavy vaginal bleeding for over a week when she went to her physician’s office. He told her she was miscarrying and discussed her need for a dilation and curettage (D&C) to stop the bleeding and protect her health. A D&C is a procedure to empty the uterus; the same technique is used for both miscarriage management and abortion.

Abortion, unsurprisingly, is firmly prohibited in Catholic hospitals (along with contraception, sterilization, most fertility treatments and related services). Care must comply with the Ethical and Religious Directives for Catholic Health Care Services written by the U.S. Bishops.

That “must” is interesting. “Must” according to whom? The bishops, the Vatican, the hospital administration, the hospital staff, the patients, the law?

And how is a hospital that “firmly prohibits” normal legal medical procedures a real hospital? Don’t people generally expect the full range of medical treatment at an institution that calls itself a hospital? Very small and/or underfunded and/or struggling ones may not provide all possible medical treatments, but then it’s a matter of “we can’t,” not “we forbid.” What business does a hospital have forbidding normal legal medical procedures? None, in my view.

Due to her heavy bleeding, Jennifer’s pregnancy wasn’t viable, but there was a chance that the fetus still had cardiac activity. Preferring not to plead with the Ethics Board about the necessity of the doing a D&C, her doctor ordered a transfusion to address her extremely low iron levels from all the bleeding, and advised expectant management, which involved waiting for Jennifer’s body to expel the pregnancy on its own. The transfusion raised her iron levels, but she still wound up in the hospital 12 hours later, as the bleeding continued. She knew she needed a D&C. Unfortunately for her, things did not move quickly in the emergency room.

There you go – Savita Halappanavar all over again. A D&C is standard of care, but instead Jennifer got something much more risky. Why? Because bishops. Not a good reason. A very bad reason.

It might not be completely clear to the lay reader — or the typical patient — where Catholic doctrine slowed down her treatment. But it was clear to Jennifer, since she worked in obstetrics. She knew they were trying to make sure the fetus had died before doing the D&C, so the miscarriage treatment would not be perceived by the Catholic hospital’s Ethics Board as an abortion. Jennifer recalled,

They did so many ultrasounds. They ended up doing, I think, three, although I may have missed one. And I remember telling them over and over again, “This is not a viable pregnancy. I’ve been bleeding enough to need a transfusion for a week. This is not viable.” And they’re like, “Well, we just need to make sure.” And I’m like, “Have you found any cardiac motion?” “No. But we need to check again because maybe we missed it. It’s very early in your pregnancy.”

They “need” to put the woman in danger because they “need” to check for a pulse in a very early pregnancy. That’s where fanaticism gets you.

Then there were more problems later in Jennifer’s life because of the transfusions.

Transfusions present risks. C-sections present risks. Both are necessary and life-saving at times. But Jennifer would have preferred not to endure those risks purely because of the hospital’s religious commitments, especially since those commitments were not her own. Had Jennifer not had so much obstetric knowledge, she would not have necessarily known that in a non-Catholic hospital she would have been offered a D&C at the outset (before the transfusions, before the seven hours of unnecessary ultrasounds). What are the chances that the average patient could understand how Catholic doctrine hindered standard treatment for miscarriage management in this case and caused unnecessary suffering?

They are slim, and of course the hospitals and their staff don’t tell the average patient that Catholic dogma is fucking up their treatment.

The burning question from a variety of outside observers of the controversial problem of Catholic hospital expansion in the U.S., including those on both sides of the debate is: If there is really a problem, why don’t we hear it from patients? Why don’t they sue? Where are their voices in this matter? Everyone wants to know including those who defend the U.S. Bishops’ right to restrict care and those who are concerned about patient autonomy and welfare.

I hope my research collecting patient experiences will shed light on these questions. For now, based on my previous research and Jennifer’s story, I can think of three possible answers: 1) patients who don’t work in obstetric care don’t fully understand how their care was affected by doctrine (i.e. might have differed in a non-Catholic hospital); 2) when patients do understand they don’t want to cast blame on health professionals who were doing their best to care for them given the institutional religious constraints; and/or 3) patients don’t want to be known in their communities for complaining about personal health care experiences that can be highly emotional and potentially stigmatizing.

Don’t forget 4) the hospitals and the bishops don’t tell anyone.

 

11 comments

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  1. 1
    Kevin Kehres

    5) religious organizations dominate the health care system in the US. In my neck of the woods, we have the Catholic hospital (really top-notch place overall), the “hospital” run by the 7th Day Adventists (complete with murals of the “real” Noah’s Ark and the Garden of Eden), and … oh that’s right …. nothing.

    Neither looks kindly on abortion, therapeutic or otherwise.

  2. 2
    smhll

    I’ll bet that they have to gall to charge her for the excessive ultrasounds and for the time she waited in the hospital.

  3. 3
    busterggi

    Jennifer is just a baby-maker, not a real person like a maybe-baby possibly dead fetus.

    At least according the the RCC and a crapload of other Christians & Muslims & ultra-orthodox Jews.

  4. 4
    Trebuchet

    That story most likely happened in my town of Everett, WA, where Providence healthcare is utterly dominating. There are a couple of other very small hospitals in outlying rural communities, but that’s about it. It’s otherwise a very good hospital but this kind of stuff is upsetting.

  5. 5
    Giliell, professional cynic -Ilk-

    I had a D&C less than 6 hours after my OB/Gyn discovered that my pregnancy had gone Wahoonie-shaped.
    I did have a second unltrasound at the hospital, with better equipment, just to make sure.
    Yeah, I would have very much liked my OB/Gyn to be mistaken, but nobody needed 3 more ultrasounds to make sure. It was bad enough as it was…

  6. 6
    iknklast

    I live in one of the few small cities in a mostly rural area. Each of the three cities has a hospital; two of these are Catholic. Many of the people are a couple of hours away from the closest hospital. I am lucky to live in the city with a hospital that is not Catholic (unfortunately, it’s not a very good hospital). We are probably a two-three hour drive away from many of these rural folks; coming here instead of to a Catholic hospital that might not give them full options could tack anywhere from half an hour to an hour onto their already long drive. This should not be allowed. No town with only one hospital should allow that hospital to be purchased by the Catholics. It should be the obligation of such towns to ensure that their facilities meet the basic needs of the people (and yes, I include women in the word people).

  7. 7
    sceptinurse

    At 1,

    Where is this SDA hospital? I worked in one for several years and we did abortions frequently. In fact it’s where my stance on abortion changed from “pro-life” to pro-choice.

  8. 8
    Ophelia Benson

    I just think there should be no such thing as a “Catholic” (or “Protestant” or any other goddy adjective) hospital. If churches and mosques want to give money to hospitals, fine, but that should be their only involvement. Medical care should be secular, period. There shouldn’t be “Catholic” engineering, and by the same token there shouldn’t be “Catholic” health care.

  9. 9
    fourth of july, asbury park

    This story sounds very similar to that of a friend of mine, only my friend is not in medicine in any capacity and only knows that the fact that she went to a Catholic hospital affected her care. She doesn’t not know exactly what the standard of care would have been.

    She went to the hospital when she was five months pregnant. They told her that she was miscarrying and there was nothing they could do to save the pregnancy. Since the fetus was not technically dead yet, they didn’t do anything. She asked for pain killers and she was told that they couldn’t give them to her because it might harm the fetus, even though they were certain it would die. Eventually it did and she went into labor and expelled the dead fetus.

    I’ve heard her tell this story to many people. It’s far from a secret. So why don’t we hear these stories from patients? One more reason, perhaps the biggest, no one is listening and no one with an audience is retelling them.

    Thank you for spreading the information about this.

  10. 10
    Numenaster

    Just last night I was cleaning out my files, and came across the 1990 and 1993 lists of excluded services from Good Health Plan (part of the Providence system, and therefore Catholic). They had an explicit exclusion for abortion and “other reproductive care that is not medically necessary.” They didn’t mention pharmacy benefits (separate plan) but as I recall birth control wasn’t covered either.

    “Not medically necessary” is such a lovely euphemism. Apparently saving a woman’s life isn’t actually medically necessary if a choice must be made. I have a feeling the bishops would count pulling a live baby from a dead woman’s body as a bigger triumph than saving the woman’s life at the cost of her child.

    So glad that at least your health plan can’t do this kind of thing any more.

  11. 11
    Trebuchet

    Physician assisted suicide is legal in Washington. Providence has signs up advising the public, basically, “We won’t do it, don’t even ask”. This worried me more than a little when my mother-in-law was there for her final days. I was worried they’d insist on heroic measures. Fortunately they didn’t.

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