Ethical and Religious Directives for Catholic Health Care Services is a publication that sets policy in Catholic hospitals and health systems. The document is written and published by the United States Conference of Catholic Bishops. The document derives medical and healthcare policy from Catholic theology and church teaching.
| Author | United States Conference of Catholic Bishops |
|---|---|
| Language | English |
Publication date | 1921 (1st ed) 1971 (4th ed) 2001 (6th ed) |
| Publication place | United States |
| Pages | 30 |
| LC Class | RA975.C37 E85 |
The document in its current form dates from 1971, with the most recent edition published 2001.
Publication history
editIn the 19th and early 20th centuries, religious rules for Catholic hospitals were published by various local and regional entities in America. An early example was published by the Archdiocese of Detroit in 1921, prohibiting abortion and sterilization. The Catholic Hospital Association began work on a uniform set of rules in the 1940s. But, no rules became official for a particular hospital or location until approved and interpreted by local religious authorities.[1]
Publication was centralized by the Conference of Catholic Bishops in 1971 to avoid different rules in different places, which was derided as "geographical morality."[2][1] The new rules resulted in "a storm of violent criticism" that the rules were inapplicable to a pluralistic society and beyond the scope of what the bishops should teach.[3] A report by the Catholic Theological Society of America found the Ethical and Religious Directives to be legalistic, inapplicable to concrete situations, and inferior to the Canadian Medico-Moral Guide. The report strongly disagreed that local bishops should possess "sole ultimate authority" to evaluate the morality of new scientific developments, and called for less attention to sex and reproduction.[3]
Cardinal John Krol persuaded most American bishops to adopt the controversial 1971 document because of the legalization of abortion in Roe v. Wade in 1973 and Taylor v. St. Vincent's Hospital, a lawsuit by a woman seeking tubal ligation, in 1975.[1] A revision in the 1990s is considered less legalistic than the 1970's document, containing more theological and philosophical explanations for its conclusions.[3] At this time, publication ceased to be attributed to the Catholic Hospital Association and changed instead to the Committee on Doctrine of the Conference of Catholic Bishops.
The document is considered to be in its sixth edition, which dates from 2001, although previous editions had different titles and publishers. The 2001 edition was updated in 2018.[4] In 2023, the Conference of Catholic Bishops voted to begin the process of updating the directives to prohibit gender-affirming care.[2] They view the transgender medical treatments as "not morally justified."[5]
Editions
editThe document's six editions are as follows:[1]
| Edition | Title | Year | Publisher |
|---|---|---|---|
| 1 | Surgical Code for Catholic Hospitals | 1921 | Archdiocese of Detroit |
| 2 | Ethical and Religious Directives for Catholic Hospitals | 1948 | Catholic Hospital Association |
| 3 | Ethical and Religious Directives for Catholic Hospitals | 1956 | Catholic Hospital Association |
| 4 | Ethical and Religious Directives for Catholic Health Care Facilities | 1971 | Catholic Hospital Association |
| 5 | Ethical and Religious Directives for Catholic Health Care Services | 1994 | National Conference of Catholic Bishops |
| 6 | Ethical and Religious Directives for Catholic Health Care Services | 2001 | National Conference of Catholic Bishops |
Directives
editThe Ethical and Religious Directives contains 49 directives within the document's six sections, many of which lay out rules that Catholic healthcare providers must follow. Notable rules include the following:
Allowed or required
edit- Service and advocacy in particular to "people whose social condition puts them at the margins of our society" including the poor, the uninsured, and "the unborn".[6]: 9
- Equal opportunity employment. Employees must be treated "respectfully and justly."[6]: 9
- Canon law of the Church must be followed by Catholic healthcare providers.[6]: 9
- Eucharist and other Catholic sacraments must be available to, and only to, Catholic patients.[6]: 10–12
Prohibited
editA number of the directives that prohibit medical procedures — namely abortion, euthanasia, and sterilization — specify that the procedure is prohibited only when "directly intended." This is because of the principle of double effect, a Catholic teaching.[7][8]
- Abortion is "never permitted."[6]: 18 Health care providers are directed to council women who have suffered "the trauma of abortion." The document reiterates that abortion is prohibited in the case of extrauterine pregnancy.[6]: 19 Nor may a victim of sexual assault get an abortion, nor may she interfere "with the implantation of a fertilized ovum."[6]: 15
- Sterilization is prohibited.[6]: 19 This prohibits tubal ligation and vasectomies.[9]
- Contraception or birth control is prohibited. Instruction on "natural family planning" may be given to married couples only.[6]: 19 Contraception is only prescribed to treat health problems, not for the purpose of preventing pregnancy.[9]
- Euthanasia or assisted suicide are not allowed. A person has a moral obligation to keep on living, though they "may forgo extraordinary or disproportionate means of preserving life."[6]: 21
- Advance directives that are contrary to Catholic teaching are prohibited. Catholic institutions must make information about advance directives available in compliance with federal law.[6]: 13–14
- Infertility treatment is permitted only within marriage, and only as long as it does not "substitute for the marriage act." For example, fertilization via sperm donor and in vitro fertilization are prohibited, as is surrogate motherhood.[6]: 17–18
Impact
editThe Ethical and Religious Directives apply in 600 Catholic general hospitals across the United States. Approximately 100 more hospitals are managed by Catholic chains that place religious limits on care.[10]
They have had more impact over time as the healthcare industry consolidates and Catholic hospitals expand.[11] The Directives state that "whatever comes under control of the Catholic institution — whether by acquisition, governance, or management — must be operated in full accord with the moral teaching of the Catholic Church."[10][6]: 26
The directives prohibit common reproductive health services. Some Catholic hospitals are literal in their application of the rules, while others are less restrictive in their interpretation.[4] A number employ workarounds to provide patient care.[12]
Fit with medical standards
editThe Directives are often at odds with accepted medical standards, especially in areas of reproductive health. For example, guidelines of American College of Obstetricians and Gynecologists specify conditions under which women should be offered the option of an abortion.[10]
References
edit- ^ a b c d O'Rourke, Kevin D.; Kopfen-Steiner, Thomas; Hamel, Ron (November–December 2001). "A Brief History: A Summary of the Development of the Ethical and Religious Directives for Catholic Health Care Services" (PDF). Health Progress.
- ^ a b O'Loughlin, Michael J. (June 22, 2023). "The controversial history of the U.S. bishops' Catholic health care guidelines". American Magazine.
- ^ a b c Hamel, Ron (November–December 2019). "100th Anniversary - The Ethical and Religious Directives: Looking Back to Move Forward". Health Progress.
- ^ a b Penan, Hayley; Chen, Amy (January 2, 2019). The Ethical & Religious Directives: What the 2018 Update Means for Catholic Hospital Mergers (Report). National Health Law Program.
- ^ Boorstein, Michelle (June 16, 2023). "U.S. Catholic bishops to create first guidelines for transgender health care". The Washington Post.
- ^ a b c d e f g h i j k l m Ethical and Religious Directives for Catholic Health Care Services (PDF) (6 ed.). Washington, DC: United States Conference of Catholic Bishops. June 2018.
- ^ Seeds, John W. (2012). "Direct Abortion or Legitimate Medical Procedure Double Effect?". Linacer Quarterly. doi:10.1179/002436312803571546.
- ^ O'Rourke, Kevin D.; Boyle, Philip J. (2011). Medical Ethics: Sources of Catholic Teachings (4 ed.). Georgetown University Press. p. 12–13. ISBN 9781589017566. OCLC 648934582.
- ^ a b Godoy, Maria (September 4, 2022). "Catholic health care's wide reach can make it hard to get birth control in many places". NPR.
- ^ a b c Pradhan, Rachana; Recht, Hannah (February 17, 2024). "The Powerful Constraints on Medical Care in Catholic Hospitals Across America". KFF Health News.
- ^ Hafner, Katie (2018). "As Catholic Hospitals Expand, So Do Limits on Some Procedures". The New York Times.
- ^ Freedman, Lori (2023). "6–7". Bishops and Bodies: Reproductive Care in American Catholic Hospitals. Rutgers University Press. ISBN 9781978828896. OCLC 1390919931.