WASHINGTON — Catholic health care faces cultural, legal, economic and political challenges that may lead to the end of its distinctively Catholic mission in the not-too-distant future, a Catholic law professor writes in a new book.
“Issues related to women’s reproductive rights may provide the most difficult challenges to the ongoing struggles by the sponsors of (Catholic) hospitals in terms of preserving their Catholic identity,” says Leonard J. Nelson III in Diagnosis Critical: The Urgent Threats Confronting Catholic Healthcare, published in June by Our Sunday Visitor.
Nelson, a professor at the Cumberland School of Law at Samford University in Birmingham, Ala., and an affiliated scholar with the Birmingham School of Public Health at the University of Alabama, sees the future of Catholic health care in free clinics; specialized centers focusing on natural family planning and other church-approved reproductive medicine; and hospice care for the dying.
“They may need to move out of the hospital setting” to aspects of medical care that are “not subject to extensive government oversight,” Nelson told Catholic News Service in a telephone interview May 28.
But the president and CEO of the Catholic Health Association sees no coming retreat from Catholic health care as we know it today, calling Nelson’s book “really a very old thesis that reappears every five to 10 years.”
“We have no reason to think we will or should close,” said Sister Carol Keehan, a Daughter of Charity, in an e-mail to CNS. “We will keep conscience protection and we will continue to be a major presence in the health care of this nation.”
Sister Keehan also said that “people who have not been in Catholic health care and have no knowledge of what it has meant in the lives of so many are too willing to give it up.”
“It is a treasure, and the care of the sick is a sign of the kingdom,” she added, “and we intend to be here being that sign.”
Nelson, a member of St. Paul’s Cathedral Parish in Birmingham, sees a sort of Catch-22 in efforts to defend the Catholic identity of hospitals from moves to dilute conscience protections in those institutions.
“Catholic institutions could bolster their claim to statutory, if not constitutional protection, from (laws that require them to act in violation of Catholic teaching) by becoming more pervasively Catholic,” he writes. “And if Catholic institutions are generally perceived to be serious about their Catholic identity, it may be easier to argue for legislative exemption from such laws.
“On the other hand, emphasizing the distinctive mission of Catholic hospitals may strengthen claims that public funding should be denied because of the sectarian nature of these hospitals,” Nelson adds.
In the CNS interview, he cited a variety of reasons for what he sees as the current dire state of Catholic health care. Among them are a lack of vocations leading to a switch in leadership of Catholic hospitals from women religious to laypeople, some of who are not Catholics; the societal trend toward viewing abortion as a “right” that should not be affected by the beliefs of others; and the economic stresses that force Catholic hospitals into “all sorts of joint ventures and mergers” to maintain financial viability.
But the greatest threat might come from the concerted effort by groups that promote or provide abortions to “mainstream abortion” by making it part of every health plan and available at every hospital, Nelson said.
“It’s going to be constant,” he said. “I don’t believe FOCA (the Freedom of Choice Act) will pass. It will be more incremental, more subtle, but we will end up in the same place.”
FOCA, which would wipe out many existing state laws and impede states’ ability to regulate abortion, has not yet been introduced in the current Congress. President Barack Obama has stated it is not a high legislative priority for him.
In the near future, “insurance plans will all have to cover abortion and the full range of reproductive services, so Catholics will be paying for it that way,” Nelson said.
He also believes it is likely that health reform under Obama will treat abortion as a right and make it more readily available and government funded.
Nelson blamed some Catholic politicians for advancing the view that it is OK to be Catholic and to support keeping abortion legal and said some bishops have not been sufficiently willing to denounce that view.
“‘Pro-choice’ Catholic politicians threaten the continued existence of Catholic health care because they provide political cover and legitimacy to efforts to impose mandates on Catholic health care institutions to provide services in violation of the ERDs,” Nelson writes.
The “ERDs” are the “Ethical and Religious Directives for Catholic Health Care Services,” which guide Catholic health-care facilities in addressing a wide range of ethical questions.
Nelson said he has been writing Diagnosis Critical for four or five years but has been interested in Catholic health care since he worked for a law firm 30 years ago that provided legal services to a Catholic hospital system.
The 229-page book contains an additional 112 pages of footnotes. Some parts of the books were published earlier as law review articles, and “I sourced the book like a law review article,” Nelson said with a laugh.