Diagnosis Critical:

The Urgent Threats Confronting Catholic Health Care

By Leonard J. Nelson III

Our Sunday Visitor, 2009

304 pages, $29.95

To order: osv.com

(800) 348-2440, Ext. 3

With health-care reform hanging in the balance, this incisive analysis of the Catholic health system couldn’t have come at a better time.

In Diagnosis Critical, Leonard Nelson, a specialist in health-care law who teaches at the Cumberland School of Law at Samford University in Birmingham, Ala., carefully details the threats Catholic institutions and providers could face under a staunchly pro-abortion president and Congress and a national health plan that could well include a mandate to provide services held by the Church to be immoral. But he also shows how some Catholic health systems may have contributed to their own eventual demise in such an environment by failing to consistently follow Church teaching and entering into compromising agreements.

Nelson begins by saying the Catholic hospital has long been the “primary bastion for the cultivation and preservation of a ‘culture of life,’” adding that pro-abortion forces clearly see the Catholic presence in health care as an obstacle to making abortion a mainstream medical procedure.

He observes that even as Catholic hospitals have increasingly come under the management of laypeople because of the decline in numbers of religious, they have held onto their Catholic identity by instilling their founding communities’ values in lay staff members. Further strengthening Catholic identity have been the U.S. Conference of Catholic Bishops’ “Ethical and Religious Directives for Catholic Health Care Services,” commonly referred to as ERDs, which spell out procedures that are morally wrong, including contraception, sterilization, abortion and euthanasia.

Despite having to balance spiritual and ethical concerns with the need to compete, Nelson writes, “Generally, Catholic healthcare in the United States has been a business success story.” He cites a 2006 survey by the American Hospital Association that said Catholic hospitals accounted for about 15.6% of all community hospital admissions in the U.S. and more than 20% of admissions in 21 states and the District of Columbia. And, Nelson adds, Catholic identity has been shown to be beneficial from a marketing standpoint.

Nonetheless, he continues, the survival of the “distinctively Catholic hospital” remains uncertain as founding religious communities decline and hospitals deal with cultural hostility to Catholic moral teaching and financial dependence on government programs.

Meanwhile, Nelson points out, Catholic hospitals may have weakened their position by failing to consistently comply with the ERDs, particularly by performing direct sterilizations on their premises.

He tells how Ascension Health System, one of the largest in the country, has employed a “hospital within a hospital” approach in Austin, Texas, and Milwaukee to meet demand for sterilization services. In both cases, separate facilities were created within existing hospitals specifically for these services.

Such measures, Nelson writes, have strengthened “the hands of those calling for the enactment of laws that would require Catholic hospitals to provide a full range of reproductive services.”

Rather than enter into complex arrangements to provide services that are incompatible with Church teaching, he suggests Catholic institutions may be better off diverting their resources to hospices for the dying or those in a persistent vegetative state or family health centers that provide natural family planning and birthing services.

Nelson cautions that the governmental system of universal health care being supported by many Catholic organizations could include a requirement that participants provide services in violation of the ERDs. Although he is concerned that Catholic hospitals ultimately may be forced to choose between continued operation and the Church directives, he expresses hope that they will remain free of such restrictions.

“But if this is not the case,” Nelson concludes, “then the path of resistance to such mandates may become necessary. … It may be that Catholic healthcare in the United States will be called upon to resist the culture of death in the face of state attempts to force Catholic institutions to provide immoral procedures.”

Judy Roberts writes

 from Graytown, Ohio.