The Cathoholic

Boston's Caritas Christi Deal--What's for Sale?

This spring, when I reported on the Caritas Christi sale to one of the nation's top private equity firms, my story noted that the new buyer would maintain the Catholic identity of the hospital network. At least, that's what I was told at the time. Now, we learn that the deal includes this option: the buyer could pay an additional $25 million to dismantle all vestiges of the network's Catholic identity, including adherence to Catholic moral teaching.

The recent controversy in Phoenix over the morality of a direct abortion at a Catholic hospital underscores the fact that mainstream health care ethics doesn't necessarily conform to Catholic teaching. Critics of the Caritas deal charge that the $25 million opt out fee suggests that even the church's commitment to the sanctity of life is for sale. An additional concern is how this opt out clause--if executed-- would affect the pro-life physicians and nurses who now serve patients through the network.

Obama-USCCB: Skirmish on Advance Directives

Last night, while driving to downtown Washington, D.C. to attend the annual dinner of the John Carroll Society, one of the great Catholic institutions in the nation's capital, I heard this NPR story about an April 15th memorandum issued by President Obama.

The memo made headlines because it directed hospitals to allow designated non-family members to visit patients and participate in health care decisions (a long-time concern for gay and lesbian couples). But the memo also addressed another issue of potential concern to Catholic hospitals: all health care facilities that receive Medicare and Medicaid reimbursements  must honor patients' advance directives. Here is the relevant part of the  White House post on the president's memo:

"2. Ensure that all hospitals participating in Medicare or Medicaid are in full compliance with regulations,codified at 42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients' representatives otherwise have the right to make informed decisions regarding patients' care. Additionally, I request that you issue new guidelines, pursuant to your authority under 42 U.S.C. 1395cc and other relevant provisions of law, and provide technical assistance on how hospitals participating in Medicare or Medicaid can best comply with the regulations and take any additional appropriate measures to fully enforce the regulations."

The NPR story predicted a possible collision between the president's stance on advance directives and the USCCB's Ethical and Religious Directives, which guide the operations of Catholic hospitals. Last fall, the U.S.bishops tightened their guidelines on tube feeding for patients, arguing that medically-assisted nutrition and hydration be generally included in ordinary care for patients.  In the wake of the  Terri Schiavo, case, the treatment of patients in a so-called "persistent vegetative state" has become increasingly divisive. The USCCB's revised directives sought to secure the rights of patients, who require medical assistance to receive nutrition and hydration and cannot speak for themselves.

Here's what the revised ERDs, approved at the fall 2009 USCCB meeting, say about tube feeding:

“While medically assisted nutrition and hydration are not morally obligatory in certain cases, these forms of basic care should in principle be provided to all patients who need them, including patients diagnosed as being in a ‘persistent vegetative state,’ because even the most severely debilitated and helpless patient retains the full dignity of a human person and must receive ordinary and proportionate care.”

At present, Catholic bioethicists and hospital administrators say that an unresolved conflict between a patient that opposed tube feeding and a hospital that insisted upon it would be very unlikely. The issue, of course, could turn on a matter of principle rather than practice. Down the road, church-affiliated hospitals may seek to legally defend their right to adhere to Catholic ethics on the treatment of patients, irrespective of whether that institution receives government funds.