Debate Over Catholic Directives That Affect 13 Percent of US Hospitals

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Haas also questioned the ACLU's claim that the directives were the reason Mean's doctor allegedly did not fully explain her medical condition or treatment options.

Haas points out that the directive 27 says the patient should be given "all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all," in order to make informed decisions.

However, medical experts say that the way the directives are implemented at hospitals can be complex and confusing for patients and what may appear to be straightforward guidelines can become murky in practice.

Dr. Margaret Moon, a physician and professor at the Berman Institute of Bioethics at Johns Hopkins, said looking at directive 27, she worried about the phrase "any reasonable and morally legitimate alternatives," when describing all treatments that should be explained to the patient.

Moon said that a doctor in a Catholic hospital could in theory not consider an abortion to be a "reasonable and morally legitimate alternative" for certain medical conditions, while other hospitals might recommend that as one treatment option.

"They've taken the notion of informed consent and put it on its head. Patients don't anticipate that," said Moon. "The Catholic Church can say a lot of things, but when they're acting in the healthcare arena, it's necessary the patients working with them understand their care."

Moon said that institutions have the right to abide by their own values but that right is complicated when they are the only source for medical care in the region.

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According to the Catholic Medical Association, 12.6 percent of U.S. hospitals are Catholic and they had 34 million admissions in 2011.

The directives instruct Catholic hospitals to transfer patients who want treatments not available at a Catholic institution. However, in practice transferring patients can be complicated especially in emergency situations or in rural areas where a Catholic hospital might be the only place to receive care in the region. In Muskegon, Mich., the Mercy Health Partners hospital was the only hospital in the county.

"I want to agree that institutions are allowed to establish their moral values and system of care, but when they have monopoly in community, there's a challenge to that," said Moon.

Moon said in recent years more and more Catholic hospitals have merged with other secular institutions. Hospitals that are well-known in a community could suddenly start to abide by directives issues by the Catholic bishops after a merger.

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