Divergent practices among Catholic hospitals in provision of direct sterilization

Abstract

Background

The Ethical and Religious Directives for Catholic Health Catholic Care Services (ERDs) are designed to promote uniform practice of health care in accordance with human and Catholic values. The aim of this study was to determine whether the ERDs are being uniformly interpreted and applied. Directive 53 prohibits the provision of direct sterilization. Hospital data were reviewed to determine whether direct sterilizations on women are being performed within Catholic hospitals and their frequency. A significant diversity of practice regarding sterilization would indicate that the ERDs are not uniformly interpreted and applied by Catholic hospitals in the United States.

Methods

All Catholic hospitals in seven states—California, Illinois, Indiana, New Jersey, New York, Texas, and Washington—were studied to determine whether diversity of practice existed in the provision of direct female sterilization. Inpatient discharge data were requested from the respective departments of health for each state for three years (2007–2009). Data from 1,734 hospitals, secular and Catholic, within the states were procured and analyzed.

Results

Of the hospitals from the seven states, 239 Catholic hospitals were identified of which 176 provided obstetric services. The patient records of these 176 hospitals were searched for those records containing the diagnostic code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system for sterilization for contraceptive management. Eighty-five or 48 percent of these hospitals provided a total of 20,073 direct sterilizations in violation of the ERDs. The entire results of the study are available on the website catholichospitals.org.

Conclusion

There is a significant diversity of practice in the provision of direct female sterilization within Catholic hospitals. Such diversity of practice indicates that there is no uniform interpretation or application of the ERDs by Catholic hospitals. Uniformity could be fostered if the ERDs mandated best practices for accountability and made use of the ICD-9-CM codes where possible to monitor actual practices. In the case of direct sterilizations reference to ICD-9-CM codes in the ERDs would minimize subjective criteria in the implementation of the ERDs.

Keywords:

• Catholic hospitals
• female sterilization
• tubal ligation
• Ethical and Religious Directives

Notes

1 Some examples are Task Force on the Religious and Ethical Directives of the CMA (2005), Carey (2008), Nelson (2009) and Congregation for the Doctrine of the Faith (1993).

2 Centers for Disease Control and Prevention, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Atlanta, Georgia, 2010.

3 Ibid.

4 Ann Carey reported on the fact that many hospital ethics committees are not current on the teachings of the Catholic Church and that there are no uniform standards for membership on such committees. She summarized a survey done by the CHAUSA and also quoted an interview with John Haas, president of the National Catholic Bioethics Center and Bishop Kevin Rhoades, chairman of the U.S. Bishops’ Task Force of Health Care.

5 HIPAA refers to the Health Insurance Portability and Accountability Act of 1996 which protects the privacy of individually identifiable health information.

6 A specific case in San Antonio, Texas, highlights this issue. A nurse reported an alleged abortion to the archdiocese and a suit was brought against her for violating HIPAA rules.

Additional information

Notes on contributors

Sandra Hapenney

Sandra Hapenney has a Ph.D. in Church-State Studies from Baylor University, an M.A. in Theology from St. Mary's University, and an M.P.H. in biostatistics and epidemiology from the University of Hawaii. She teaches epidemiology at Baylor University and theology at Reicher Catholic High School. Her email address is [email protected]. This study was conducted as part of her dissertation titled Appeal to Conscience Clauses in the Face of Divergent Practices among Catholic Hospitals. It may be viewed in its entirety at catholichospitals.org or through the UMI database of dissertations.