MILWAUKEE — Archbishop Rembert Weakland of Milwaukee is awaiting a report from the National Catholic Bioethics Center and other ethicists. It will help him decide whether a new partnership between a local Catholic hospital and another institution that allows sterilization services violates the U.S. bishops' revised health care directives.

At Rome's request, the bishops revised and clarified their Ethical and Religious Directives for Catholic Health Care Services in June. Now they say that “Catholic health care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide, and direct sterilization.”

During the June bishops' meeting where the directives were revised, Archbishop Daniel Pilarczyk of Cincinnati, the chairman of the committee that wrote the changes, was quoted in news reports as saying that arrangements seeking to circumvent Church prohibitions against abortion and sterilization through the creation of legally separate entities within hospitals would no longer be allowed.

But under a recently announced plan by Columbia-St. Mary's, a partnership sponsored by Columbia Health System and Ascension Health, tubal ligations and vasectomies will be performed at Columbia Center, an independent, 45-bed birthing facility located in Columbia Hospital. No abortions may be performed in Columbia Center under the agreement between the two health systems.

As a result of its partnership with Columbia Health System, Ascension Health has operated Columbia Hospital since Oct. 1. Ascension Health is sponsored by four provinces of the Daughters of Charity and the Sisters of St. Joseph of Nazareth.

The center owns the space it occupies in Columbia Hospital under a condominium arrangement, said Kathy Schmitz, a Columbia-St. Mary's spokesman. The Milwaukee Journal Sentinel reported that the third floor of the hospital will be turned into the independent center where sterilizations will be performed, but Schmitz declined to confirm where the center will be physically located.

“It's a completely separate business from Columbia-St. Mary's and Columbia Hospital,” Schmitz said, comparing the arrangement to locating a bank within a grocery store. “They're located at the same site, but they operate and function as separate businesses.”

Schmitz said that as a legal entity, Columbia Center was created by Columbia Health System before the partnership was forged “to respect the guiding principles of both sponsors, and to allow both sponsors to continue to operate in a manner consistent with their own beliefs.”

She said the relationships among the parties involved comply with the section of the U.S. bishops' Ethical and Religious Directives that limit participation by the Catholic partner to what is in accord with the moral principles governing cooperation.

Archbishop Pilarczyk declined to comment on the Columbia Center project, saying that it is the responsibility of the local bishop to determine if a specific health care arrangement represents material cooperation with immoral actions, or gives rise to scandal.

“The archbishop does not wish to comment on the Milwaukee hospital situation because it is outside his jurisdiction and responsibility as a bishop,” said Dan Andriacco, Archbishop Pilarczyk's spokesman. “He notes that No. 71 of the revised Ethical and Religious Directives for Catholic Health Care Services makes it clear that it is up to the local ordinary to apply the directives: ‘The diocesan bishop has final responsibility for assessing and addressing issues of scandal, considering not only the circumstances in his local diocese but also the regional and national implications of his decision.’”

The revised directives, which were drafted at the behest of the Vatican and approved by the bishops in a 209-7 vote, give local bishops the authority to approve such partnerships, or to grant a nihil obstat (expressing no objection on moral grounds) in cases where one of the sponsors is a religious pontifical institute.

Archbishop Weakland has known about the Columbia Center project for months, his spokesman, Jerry Topczewski said, but because Ascension Health is operated by a religious congregation that reports directly to Rome, the archbishop's role will involve the nihil obstat. This means that he will not stand in the way of the project if it meets the demands of the congregation's superiors, Topczewski said.

The archbishop received final legal documents on the arrangement the week of Nov. 4, but has insisted on seeing reports from the National Catholic Bioethics Center and other ethicists who have been consulted, he said.

The spokesman added that Archbishop Weakland has been told that all the proper consultations have taken place and that the National Catholic Bioethics Center has reviewed the proposal, “providing assurance that all of the ethical and religious directives for Catholic health care services have been strictly followed and will remain intact under this new operating structure.”

The National Catholic Bioethics Center declined to comment to the Register on the Columbia Center project.

Judgment Call

Father Michael Place, president and CEO of the Catholic Health Association of the United States, an organization of more than 2,000 Catholic health care organizations, said that although his group leaves judgments on such partnerships to local bishops, the Columbia-St. Mary's agreement appears to constitute acceptable cooperation.

If the non-Catholic partner in such an arrangement chooses to create a separate, independently managed and licensed health-care institution and there is no mingling of revenue, Father Place said, then the moral question becomes how the Catholic party is cooperating in evil.

“I think the moral analysis would suggest that if those facts are correct, most orthodox moral theologians I have read would conclude that does not involve a violation.”

He said arrangements that provide for sterilizations to be done at a location that is not jointly owned or managed by a Catholic partner are neither unusual nor common.

But even when cooperative agreements are morally licit, the bishops' directives say they may be refused because of the possibility of scandal.

Father Place said scandal is “a very nuanced theological category” that has to be evaluated in the context of the particular arrangement.

The Ethical and Religious Directives, he said, state that a Catholic partner can be in a relationship with someone who does what the Church considers wrong provided “we are not involved in the doing of the evil.” The bishops have said this does not apply in the case of abortion, he added.

Creation of the independent Columbia Center may have exempted the Catholic sponsors of Columbia-St. Mary's from material cooperation in sterilization services, but they still face a problem of scandal, according to a moral theologian who serves on several hospital boards.

Father Thomas Lynch, a lecturer at St. Augustine's Seminary in Toronto, said the sheer proximity of the center to Columbia Hospital, which is part of the Columbia-St. Mary's cooperative agreement, could cause scandal because of the potential for misunderstanding. To remedy that, he said the Catholic partners in Columbia-St. Mary's will have to make clear that they do not agree with what is going on in the center.

“We have to be really careful to uphold Catholic teaching obviously and vocally in this area.”

He cited as an example a situation in Toronto in which a Catholic hospital took over another hospital that had had an abortion clinic within it. For the clinic to continue, he said, it had to re-establish itself as a completely separate entity.

“Before the public hospital joined the Catholic hospital, it severed its relationship with this abortuary … If it is incorporated separately, we are not materially cooperating; however, we must make very, very clear what is being done.”

In contrast, Michael O'Dea of the Christus Medicus Foundation, which was formed to educate people about the need for Christ-centered health care, thinks arrangements like the one at Columbia-St. Mary's violate Church teaching.

O'Dea said the Milwaukee arrangement appears similar to a method many Catholic health plans have used to provide coverage for abortion, sterilization, and contraception services by contracting with a third-party administrator. “Because they don't touch the money, they have been able to convince the bishops that this is okay,” he said.

Added O'Dea, “They can say they don't have Catholic people doing this or their organization is not doing this, but when they set up one of these bypass mechanisms or arrangements … I don't understand why the bishops can't see that that is cooperation in evil. We do not help facilitate people to get sterilized. To me, they are clearly doing this in those situations.”

Catch 22?

When Catholic institutions get involved in arrangements that allow services prohibited by the Church to continue, said Msgr. William B. Smith, professor of moral theology at St. Joseph's Seminary, Yonkers, N.Y., “You really have to put on a new set of eyeglasses, because what you have is a change in words without a change in reality. They can say this doesn't happen on their property or by their staff, as far as we know, but the problem is you have merged or partnered yourself with someone who has this ‘separate little entity.’”

Msgr. Smith added that the revised U.S. bishops' directives on Catholic health care institutions do not adequately address such issues. That leaves their interpretation to moral theologians, he said, “which puts us exactly back to what got us in trouble in the first place.”

Judy Roberts writes from Millbury, Ohio.