Despite federal and state laws designed to protect conscience rights, Catholic medical professionals and their advocates report that health-care institutions routinely pressure their employees to provide or refer for services to which they morally object — and Catholic institutions are not immune to this tendency.
Francis Manion, senior counsel with the American Center for Law and Justice (ACLJ), told the Register that these conflicts are “quite common.” The ACLJ’s mission of defending constitutional liberties includes safeguarding the conscience rights of medical personnel.
“In just the past two weeks,” Manion told the Register last month, “I have spoken with a nurse threatened with termination for questioning her hospital’s allowing an abortion to be performed, a doctor threatened with firing over her request to be accommodated when faced with administering a certain drug that she believes is an abortifacient, and a technician told he must sign a form that would effectively require him to participate in abortions whenever his employer unilaterally decides that patient care requires him to.”
Dr. Jozef Zalot, a staff ethicist at the National Catholic Bioethics Center (NCBC), says that it is “not uncommon” to receive inquiries even from employees at Catholic health-care institutions who feel that their consciences are being violated. “In fact, I’ve had doctors tell me that actually, in a lot of cases, secular hospitals do a better job of protecting conscience than do Catholic hospitals. It’s bad.”
Megan Kreft’s Case
Megan Kreft, a physician assistant in Oregon, contacted the NCBC with ethical concerns soon after she was hired last year by Providence Medical Group, a Catholic institution founded in the 1800s by the Sisters of Providence.
As a condition of her employment with Providence, Kreft was told that she must agree to abide by the U.S. Conference of Catholic Bishops’ “Ethical and Religious Directives for Catholic Health Care Services” (ERDs). Kreft was delighted.
The bioethical challenges Kreft encountered while earning her degree at Oregon Health and Science University had led to her decision, upon graduation, to avoid working in women’s health or family medicine.
“I just found those were the two areas that these life issues,” she said, “these bioethical things, kept popping up that seemed so contrary to my beliefs and my faith and my conviction of what really true good medicine is, even just from a medical and research standpoint.”
Providence’s policy that all providers must abide by the ERDs reassured Kreft that she could serve her patients according to the dictates of her conscience. She accepted a family medicine position at Providence Medical Group Sherwood, an outpatient clinic.
Before beginning work, Kreft found out that other providers in the clinic were performing sterilizations and prescribing hormonal contraception, although these are clearly contrary to the ERDs. Still, Kreft thought that she would be allowed to practice medicine in line with the teachings of the Church.
Soon after Kreft began working for Providence, a patient — who had come in for other reasons — asked her for emergency contraception, also known as Plan B or the “morning-after pill.” Kreft gently told the patient that she didn’t prescribe or refer for emergency contraception, but offered her other help.
Later, Kreft was called into a meeting with her medical director and the regional medical director, who told her that she had broken the Hippocratic Oath and traumatized the patient who had requested emergency contraception.
At this point, Kreft emailed the NCBC to ask for guidance and came in contact with Zalot.
“I knew that I could count on NCBC helping me navigate some of these very nuanced ethical situations, as well as the nuances between the intersection of clinical practice, theology, philosophy and bioethics,” Kreft said.
“Whatever support we gave, Megan’s the real hero in all of this, for standing up to a Catholic health-care system that basically isn’t Catholic anymore,” Zalot said.
After Kreft told her manager she would not provide or refer for sterilizations, assisted suicide, transgender surgeries, abortions or contraception, she was prohibited from seeing any women of childbearing age.
Less than a year after being hired, Kreft was fired for refusing to sign a document that stated that she would refer for services she could not in good conscience provide.
“As you can imagine, I was confused,” Kreft said, “because this seemed to directly contradict what my employment contract stated, which is that the institution and all providers are required to adhere to the ERDs, which so explicitly state that these services are not permitted in Catholic health care. So I was being asked to refer patients to other providers in the organization for services which the organization purported to not permit. I pointed this out. You have to do gymnastics in your head.”
Providence Medical Group did not respond to requests for comment.
Kreft settled her personal claims against Providence through mediation and has filed a federal complaint with the Health and Human Services’ Office for Civil Rights.
In January 2018, the Trump administration created a new Conscience and Religious Freedom division within the HHS office, dedicated to enhancing protections in this area for health-care workers.
Roger Severino, director of the Office for Civil Rights, said that employers’ discrimination against medical professionals because of their ethical or religious principles creates “an extraordinary moral injury.”
“There’s a movement that tries to squelch dissent on the question of abortion so that those that stand up for life are being systematically driven out of the medical profession,” Severino said. “Nobody should be fired from their position as a medical professional because they refuse to participate in the taking of a human life in abortion. It’s illegal, if you receive federal funds. You may expect an enforcement action from the HHS Office for Civil Rights, if you do such a thing.”
Manion, however, pointed out that the federal conscience statutes depend on the government itself for enforcement.
“An individual can’t just sue under the federal conscience laws,” he said. “An individual can complain to the appropriate federal agency, such as HHS, about violations and hope the agency will act. Right now, we have a receptive audience at the Conscience and Religious Freedom division. But a change in administrations in Washington could very well spell the end of that division as an effective helper.”
Sometimes the pressure to comply with employer demands is more of an intimidation campaign than easily-proven discrimination or unlawful termination.
A hospice nurse of 23 years in California — who wishes to remain anonymous — was placed on leave earlier this month when she asked if she could be a “conscientious objector” to general inpatient hospice care.
Hospice includes several levels of care, under which a patient may live for years. The nurse mentioned a man she attended for 10 years who died this month at age 102.
General inpatient hospice care usually takes place in the hospital. The hospital calls the hospice or visiting nurse company to come into the hospital and take care of terminal patients who have no one to care for them at home.
“We hook them up to the morphine drip and we say goodbye,” the nurse said. “You put them on a drip, and it’s like a sayonara.”
“That, to me, smacks of euthanasia,” she said. “So when I brought this up at work, it was like Chicken Little and the sky is falling. And I’m on leave; they’re not paying me. And they’re not communicating with me.”
“If you were to ask any other hospice nurse about general inpatient hospice, ‘Does it ever look like euthanasia to you?’ Everybody would say, ‘Yes, it does.’ A lot of people refuse to do it.”
She resigned when her company did not let her return to work.
Manion said that discrimination is easy to prove when there’s a paper trail of an employee requesting to be excused on religious grounds and the employer refusing.
“More difficult are cases where retaliation is subtle, indirect, where pretexts are found to discriminate against an objecting employee,” he said. “Educating health-care workers about the mosaic of legal protections available to them is crucial. Of course, there is the practical difficulty of an employee not wanting to risk losing a job or a career. Many try to lay low and hope and pray that they can avoid a direct conflict over these issues. But it really shouldn’t be that way.”
Dr. Toffler’s Case
Dr. William Toffler worked at Oregon Health and Science University for 34 years until last October, when he was put on leave until his contract expired at the end of the year. He first joined the family medicine department as one of only four or five members. It has since grown to more than 150 members.
During his years of practice, he found that most of his patients were open to hearing the scientifically documented detrimental effects of contraceptives or other services that are contrary to the teachings of the Catholic Church and which he did not provide.
Toffler said, “Apart from the ideologues that were bothered by my talking about this, most women were appreciative.”
Although previous chairs of the family medicine department took pride in having physicians with diverse opinions in the department — alongside Toffler, who is well known for opposing assisted suicide, a leading proponent of assisted suicide was also a member of the department — Toffler said that the current chair does not.
“Talking to people about either contraception or abortion is a third rail, and there is absolutely no tolerance for my diversity,” Toffler said. “It’s interesting because I was in an institution that clearly has a mantra, ‘honor diversity’ and has a wall literally dedicated to the efforts it’s made to honor diversity. That’s great. I’m all for it. But it is interesting how that is the rhetoric, yet the reality with respect to my particular case is that they’re not.”
Toffler described one of the complaints that led to his dismissal.
“A pre-medical student who I told about problems with contraception complained, ‘Dr. Toffler made me feel guilty about using birth-control pills,’” he said. “And that is sort of a mortal sin to my chair. And not just to her, I think to the current leadership of the Department of Family Medicine at Oregon Health and Science University. So we have people who are somewhat intolerant of someone who has my beliefs.”
Another complaint about Toffler came after he discussed sex-change operations with a colleague.
“I was talking about the concept and somebody overheard; and that, to the current chair, is a hostile work environment because I said the truth about what the epidemiology, anthropology of having a sex-change operation is, based on data,” he said. “That is also something you can’t do in the workplace, according to the current leadership.”
He was put on leave in October. Toffler, who mentored Kreft while she was a student, is now opening a primary care clinic in Portland, along with a growing number of other providers who want to practice authentically Catholic medicine. The nonprofit organization is scheduled to open this summer as Holy Family Catholic Clinic.
Oregon Health and Science University would not comment on Toffler, but provided a statement.
“OHSU honors, respects, embraces and values the unique contributions and perspectives of all our members,” it said. “We do not tolerate harassment or discrimination of any kind. OHSU is committed to providing a safe and affirming place for people with different religions, ethnicities, abilities, racial or socioeconomic backgrounds; LGBTQ and gender-nonconforming communities; immigrants; Dreamers; among others.”
The university did not respond to a request to clarify whether it honors and values unique perspectives of its members that might, in another member’s perspective, be perceived as harassing or discriminatory.
Kreft said she wants other health-care workers to avoid the feeling that she had of fighting on her own.
“It felt very isolating at times, and I’ve even questioned my vocational call to practice medicine,” she said.
“My goal in sharing my story is to be an advocate for other health-care professionals who might find themselves in similar situations, whether it be at secular institutions or even Catholic institutions,” Kreft said, “and also to bring to light some of the unfortunate assault on human life that’s happening even within our Catholic institutions.”
Register correspondent Mary Rose Short writes from California.