The Catholic Church is one of the largest non-government (NGO) providers of healthcare services in the world.[1] According to available data, the religious organization operates approximately 18,000 clinics, 16,000 homes for the elderly and those with special needs, and more than 5,500 hospitals, with 65% percent of them located in developing countries.[2] 

In 2010, the Church’s Pontifical Council* for the Pastoral Care of Health Care Workers said that the Church manages 26% of the world’s health care facilities. [3]

In the United States, the Catholic Church is among the largest private provider of health care. [3] In the 1990s, the church provided approximately one in six hospital beds in in the United States in 566 hospitals.

Many of these hospitals were established by nuns.[4] For example, the Sisters of Mercy, was founded by Catherine McAuley in Dublin in 1831 when decided to use an inheritance to build a large house on Baggot Street (Irish name: Sráid Bhagóid)** in Dublin, Ireland, as a school for poor girls and a shelter for homeless servant girls and women and help them overcome the effects of poverty, sickness, and lack of education.

In 1854, eight members of McAuley’s group arrived in San Francisco, California to help in caring for residents of a city struck by cholera, then typhoid and influenza. They founded St. Mary’s Hospital, which today is one of the oldest continuously operating hospitals in the city. This single hospital eventually became part of an organization with many hospital and care facilities.

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In 1986, the Sisters of Mercy merged their ten hospitals into one organization (Catholic Healthcare West or CHW), which, 2012, we became Dignity Health, operating a network of both Catholic and other-than-Catholic medical facilities.

In 2019 Dignity Health and Catholic Health Initiatives (CHI) merged to create CommonSpirit Health, one of the nation’s largest nonprofit faith-based health systems with more than 1,000 care sites supported by 150,000 health care professionals, including 25,000 physicians and more than 40,000 nursing professionals.

A 2022 report indicated that four of the ten largest healthcare systems in the United States, including CommonSpirit Health, were Catholic. Forty-six states have Catholic hospitals, with 14% of the hospital beds under Catholic ownership — exceeding 40% of the beds in some states. This reach and its implications for the care of millions of Americans is not well understood.

Universal Healthcare
In addition to this ‘ownership’ of healthcare, the Catholic church has carried a disproportionate large number of poor and uninsured and underinsured patients. At the same time, the church pressured governments around  globe to improve healthcare.  For example, in 1919 the church was among the first organizations in the United States to call for universal health care (also known as universal health coverageuniversal coverage, or universal care) in the United States.[4]

In 2012, the church operated 12.6% of hospitals in the US, accounting for 15.6% of all admissions, and around 14.5% of hospital expenses (approximately 98.6 billion dollars). Compared to the public system, the church provided greater financial assistance or free care to poor and under or uninsured patients, providing various low-profit health services such as breast cancer screenings, nutrition programs, trauma, and care of the elderly. [5]

Church and Healthcare
A new book written by Patricia Gabow, MD, MACP, and  published by the American Association for Physician Leadership (AAPL), examines the history, evolution, and current relationship of the Catholic church and U.S. healthcare.

The book is entitled The Catholic Church and Its Hospitals: A Marriage Made in Heaven?

The book traces the history of Catholic healthcare from its presumed biblical foundation to the women religious who established clinics and hospitals to provide care to those in need, and to the formation of large, wealthy healthcare corporations with rules that dictate the healthcare for many, both Catholics and non-Catholics.

The Catholic bishops, through 77 rules known as the Ethical and Religious Directives for Catholic Health Care Services (ERDs) to which all Catholic hospitals in the United States are required to adhere, determine what care can and cannot be given to patients. This has significant implications for both physicians and patients.

Reach of rules
However, physicians, healthcare providers, policymakers, and patients do not always understand the reach, the rules, and their implications of the ERD, which id governed by a surprising lack of institutional transparency. Consequently, patients often do not know if their hospital is Catholic, what types of care are prohibited, and that their doctors must follow the ERDs.

For example, in December 2010 Bishop Thomas J. Olmsted ordered St Joseph’s Hospital and Medical Center in Phoenix to no longer identify itself as Catholic, issuing a decree in which he revoked the 115-year-old hospital’s affiliation with the Catholic Church. In his decree, Olmsted wrote that he could not verify that the hospital provided healthcare services consistent with ‘authentic Catholic moral teaching.’

Olmsted issued his decree after the hospital publicly acknowledged that an abortion occurred at the hospital in late 2009.  At that time he explained that authority to revoke the Catholic identity of St. Joseph’s Hospital, was based on his interpretation of Canon 216, which says that: ‘No undertaking is to claim the name Catholic without the consent of competent ecclesiastical authority.’

Commenting on the conflict between the church and Dignity Health, Linda Hunt, then the President and Chief Executive Officer of Dignity Health’s Southwest Division,*** stated that ‘consistent with our values of dignity and justice, if we are presented with a situation in which a pregnancy threatens a woman’s life, our first priority is to save both patients. However, if that is not possible, we will always save the life we can save, and that is what we did in this case.’  Following the fallout, St. Joseph’s Hospital and Dignity Health (then called Catholic Healthcare West or CHW) maintained that the intention was to save “the only life that could be saved,” which was, according to the hospital’s medical directors, in this case the mother’s life.

Not Unique
The withdrawal of a hospital’s identification or affiliation with the Catholic Church is not unique.  In 2010, in an unrelated case, Bishop Robert F. Vasa of Baker, Oregon directed that St. Charles Medical Center in Bend, Oregon, founded in January 1918  by the Sisters of St. Joseph of Tipton, Indiana, could no longer be called Catholic because, in his view, Oregon’s largest medical center refused to adhere to some Catholic teachings when it agreed to provide female patients with tubal ligation, a surgery to close a woman’s fallopian tubes which connect the ovaries to the uterus (sometimes called ‘tying the tubes’), a form of permanent female reproductive sterilization.

Contributions and concern
This book underscores Catholic Church healthcare contributions and uncovers areas of concern about the church’s mission fidelity and function. From that prospective, Patricia Gabow presents her readers with more than just a historical overview or a critique: she makes a compelling set of argument and recommendations for re-examining government policies and practices to ensure the Catholic health system stays true to its roots of service and charity and to its role in our society.

“No magic wand exists to create this return of Catholic healthcare to its old path or facilitate its building new roads,” noted Gabow.

“Even agreeing that change is needed would be transformational. If the Catholic healthcare institutions adopted the suggestions made in the book, it would be an enormous step forward; American healthcare and society would be better and stronger.”

“We can [only] hope […] that the Catholic church and its hospitals can be a marriage made in heaven,” Gabow concluded.

“We’re reminded of our mission: It is our core belief that all physicians are leaders, and as such are especially vital in determining and effecting better healthcare services delivery and patient outcomes,” said Peter Angood, MD, FRCS (C), FACS, MCCM, FAAPL(Hon), president and Chief Executive Office of the American Association for Physician Leadership.

“Gabow has thoroughly researched this issue, the examination and discussion of which is fundamental to our delivering on that mission. We believe also that clarity and transparency are always the best ways to avoid misunderstandings.”

Influence policy
Originally intended for policymakers and (healthcare) payors, politicians, healthcare leaders, physicians, insurers, patient advocacy groups, ethicists, investigative journalists, legal scholars, Catholic leaders, academics, and students in health administration, the book offers a comprehensive overview of a unique and critical aspect of American healthcare and focused on improving patient outcomes, workforce wellness, and a refinement of all healthcare delivery.

However, in her book, Patricia Gabow also reaches out to Catholics and the (non-Catholic) general public — and anyone interested in the complex interplay of religion, (excessive) power, healthcare, and society.

Without a doubt, The Catholic Church and Its Hospitals: A Marriage Made in Heaven? takes readers on an enlightening expedition through the annals of the United States Catholic health system.

According to the publishers, this book will open eyes of its readers to the history, rules, reach, and healthcare implications of Catholic healthcare in America. It will ask readers to consider how transparent healthcare institutions should be with their patients. It will ask readers to examine what it means to be a not-for-profit healthcare institution. And finally, it will ask readers to examine the boundaries between the exercise of beliefs by hospitals and physicians and the delivery of healthcare in America’s pluralistic society.

Note: * A pontifical council was a mid-sized department or dicastery of the Roman Curia, the central organization responsible for assisting the Pope in the governance and oversight of the Catholic Church. Such a council had a cardinal or archbishop as its president and was restricted in its activities in comparison with the larger parts of the Curia. Pope Francis has undertaken a reorganization of the Roman Curia eliminating several councils by incorporating their activities into parts of the curia with broader responsibilities. Since Praedicate evangelium (from Latin, meaning: ‘Preach the gospel’) a Constitutio apostolica (from Latin, meaning: ‘Apostolic constitution’), a form of legislation issued by the Pope designed to reform the Romana Curia (from Latin, meaning ‘Roman Curia’), the  administrative institutions of the Holy See and the central body through which the affairs of the Roman Catholic Church are conducted [6] took effect on June 5, 2022, there are no more active pontifical councils.

** Baggot Street is named after Baggotrath, a feudal manor granted to Hiberno-Norman judge Robert Bagod in the 13th-century. He also built Baggotrath Castle, which was partly destroyed during the 1649 Battle of Rathmines and demolished in the early nineteenth century.

*** After 51 years of service to the health care industry, Linda Hunt retired in January 2022.

[1] John Agnew (2010) Deus Vult: The Geopolitics of the Catholic Church, Geopolitics, 15:1, 39-61, DOI: 10.1080/14650040903420388
[2] Calderisi, Robert. Earthly Mission – The Catholic Church and World Development; TJ International Ltd; 2013; p.40
[3] Catholic hospitals comprise one quarter of world’s healthcare, council reports. Catholic News Agency (CNA). February 10, 2010. Last accessed on November 23, 2023. [Article]
[4] The Health Care Debate: The Catholic Church; Catholic Leaders’ Dilema: Abortion vs. Universal Care; by Gustav Niebuhr, New York Times, 25 August 1994.[Article] Last accessed on November 22, 2023
[5] Edward Morrissey “Obama Risks $100 Billion If Catholic Hospitals Close”. The Fiscal Times. February 29, 2012. Last accessed on November 22, 2023
[6] Wooden, Cindy (19 March 2022). “Pope promulgates Curia reform, emphasizing church’s missionary nature”Catholic News Service. March 19, 2022. Last accesses on November 23, 2023.

Featured image: by camilo jimenez on Unsplash. Used with permission.

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