St. Charles Medical Center in Bend lost the title “Catholic” on Feb. 15 due to its refusal to stop doing tubal ligations to sterilize women. Founded by the Sisters of St. Joseph in 1918 but no longer run by them, St. Charles is Oregon’s only Level II trauma center in the central and eastern part of the state.
“The crux of the conflict was the hospital and ethics board’s intentional misinterpretation of ‘direct’ and ‘indirect’ sterilizations,” said Diocese of Baker Bishop Robert Vasa. After several years of negotiations with St. Charles, Bishop Vasa made the difficult decision to strip the hospital of its “Catholic” status.
Tubal ligation, informally known as “getting one’s tubes tied,” is always a direct form of female sterilization not permitted in Catholic health-care institutions. But, based on the Catholic principle of double effect, other procedures that indirectly induce sterility — the removal of cancerous fallopian tubes or ovaries, for example — are permitted in situations where no simpler remedy is available.
“The heart of my conflict here is that the hospital and the ethics board identified all of these 200 to 250 sterilizations they do a year as indirect,” Bishop Vasa said.
A typical case at issue would be that of a mother with three children. A doctor may decide it could be “dangerous” for her to get pregnant again. In such a circumstance, St. Charles’ hospital and ethics board claimed it was permissible under the directives for a surgeon to sterilize the mother with the “indirect” intention of keeping her healthy.
“Clearly, that’s a direct sterilization with the secondary hope of preserving her health,” Bishop Vasa said. “So it was in my mind an intentional misrepresentation and misinterpretation of that teaching.”
Further, the bishop stated, “It is possible that this teaching about sterilization may be misunderstood and misrepresented in a number of Catholic hospitals nationwide.”
To be called “Catholic,” a health-care institution must follow the “Ethical and Religious Directives for Catholic Health Care Services” issued by the U.S. Conference of Catholic Bishops. Paragraph 53 of the directives states: “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health-care institution.” A second sentence reads: “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.”
This second sentence is often made the illegitimate pretext for sterilizations at Catholic hospitals.
Nevertheless, Hamel is executive editor of the quarterly CHA publication Health Care Ethics USA: A resource for the Catholic health ministry, which until Feb. 24, 2010, was posted on CHA’s website. In one article, Hamel posed the question, “The CDF Statement on Artificial Nutrition and Hydration: What Should We Make of It?” in which he personally interpreted the Vatican’s position on the matter.
Speaking as CHA’s senior director of ethics, Hamel wrote that there are “questions about the accuracy of the medical assumptions in the CDF statement and commentary.” An unsigned “primer” on the Vatican’s statement published in the same issue stated that if a patient has “objective discomfort that a reasonable person would describe as unacceptable subjective discomfort, the withdrawal of [artificial nutrition and hydration] would appear to be permissible.”
Another Health Care Ethics USA article, not authored by Hamel, stated, “The ethical distinction between allowing-to-die and euthanasia depends, for the most part, on the medical condition of the patient,” while a third article noted that the “autopsy after [Terri Schiavo’s] death belied any thought that she would have recovered.”
The fall 2007 issue of Health Care Ethics USA published “A Resource for Evaluating Levels of Authority in Church Teaching,” with the “pope’s [sic] ordering of a document’s publication” by the Congregation for the Doctrine of the Faith said to carry the least “theological weight.”
The title page of Health Care Ethics USA grants permission to Catholic Health Association members “to copy and distribute” the publication free “for educational purposes.”