In 1971, the National Conference of Catholic Bishops created the Ethical and Religious Directives for Catholic Health Care Services (the Directives). The Directives are principles that guide healthcare provisions and deliveries at Catholic-affiliated healthcare institutions. The latest edition of the Directives was published in 2001.
The Directives are 72 principles that inform the “Church’s healing ministry.”1 They provide moral guidelines for medical care and regulate such services as contraceptive provision and counseling, sterilization, abortion, condom use discussion, assisted reproduction, end-of-life treatment options and embryonic stem cell research.
What the Directives Dictate
Several of the Directives have a direct impact on reproductive healthcare provisions and patient care:
- Directive 24: Advance Directives
Catholic healthcare institutions, in compliance with federal law, must inform patients about their right to make an advance directive for medical treatment. However, the institution “will not honor an advance directive that is contrary to Catholic teaching.” Institutions must explain the conflict to the patient and why it cannot be implemented.
- Directive 41: Infertility Treatment
“Homologous artificial fertilization (that is, any technique used to achieve conception using the gametes of the two spouses joined in marriage) is prohibited when it separates procreation from the marital act in its unitive significance (e.g., any technique used to achieve extra-corporeal conception).” By omission, this also prohibits infertility treatment for single/unmarried women and patients in same-sex relationships.
- Directive 45: Abortion
This Directive states that abortion, defined as “the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus … which, in its moral context, includes the interval between conception and implantation of the embryo,” is never permitted. It continues, “Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.”
- Directive 48: Ectopic Pregnancy
“In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”
- Directive 51: Embryonic Stem Cell Research
This Directive prohibits “nontherapeutic experiments on a living embryo or fetus,” even when consent is given. It allows for therapeutic experiments to be performed “for a proportionate reason with the free and informed consent of the parents or, if the father cannot be contacted, at least of the mother.”
- Directive 52: Contraception
Catholic institutions are not permitted to “promote or condone contraceptive practice,” but should instruct married couples about methods of “natural family planning” and about “the Church’s teaching on responsible parenthood.” By omission, discussion of STI/HIV prevention is also prohibited.
- Directive 53: Tubal Ligation and Vasectomy
This Directive prohibits both temporary and permanent sterilization of women and men, noting that “procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”
How the Directives Affect Physicians
The Directives affect patient care in several ways. Most commonly, they place limitations on physicians who are employed by religious institutions or affiliates that adhere to the Directives. Physicians are often required to sign a contract agreeing to adhere to the Directives as a condition of receiving admitting privileges, although most physicians report that the contract does not include an actual copy of the Directives.
Additionally, these restrictions are extended to physicians who rent spaces from religious entities. Often, the lease to the space will require renters to adhere to the Directives.
How the Directives Affect Patients
Healthcare systems in the United States are complicated and severely flawed. Patients are often faced with numerous obstacles and challenges in order to meet basic healthcare needs. With the growing number of religiously affiliated hospitals and HMOs, patients are often caught by surprise when a needed treatment is not offered at their hospitals or covered by their insurance companies.
For certain populations, such as patients using Medicaid or rural patients, the challenges are even greater. These marginalized patients are left with few options but to accept the medical care that is dictated by a religious institution, or travel long distances and face prohibitive costs to get the medical care they desperately need. It is the economically disadvantaged who bear the greatest brunt of the healthcare system’s shortcomings. Every patient deserves comprehensive healthcare and the opportunity to live a healthy life, regardless of his or her income.
For more information on ways in which religious restrictions interfere with patients’ health, contact firstname.lastname@example.org.
1 National Conference of Catholic Bishops. The Ethical and Religious Directives for Catholic Health Care Services, 4th Edition. Available at: http://www.nccbuscc.org/bishops/directives.shtml. Accessed October 17, 2006.