Catholic healthcare just can't seem to stay out of the news. This time, Mercy Hospital in Redding — citing its commitment to church teaching — has refused to tie the tubes of one of their patients after a C-section delivery. A Superior Court judge in San Francisco has said the hospital can make that choice, but the ACLU is suing on behalf of the patient. This debate hinges on a central question in medical ethics: What is healthcare?
You might be tempted to think this is pretty easy to answer, but in reality our culture is constantly wrestling with this question.
California just spent more than a year having a debate about whether assisting a person in dying should be considered healthcare. We are constantly faced with old questions (is there an appropriate age at which we stop doing knee replacements?) and new questions (should we respect claims of "bodily integrity identity disorder" and have perfectly healthy limbs cut from someone's body?), which push and challenge our understanding of healthcare.
Unfortunately, medical practice isn't much help here. Some will refer to "the standard of care," but all this tells us is what most hospitals and physicians are doing. It doesn't tell us why they do it, or if it's right.
Healthcare providers (whether they know it or not) make these kinds of judgments based not so much on medical training but on values and ethics. Whether one is a "maximize happiness" utilitarian, a care-centered feminist, a neoliberal capitalist or a justice-seeking Roman Catholic, these values are what forms one's foundational understanding of healthcare.
Our liberty-centered culture has tried to make space for multiple value systems. Indeed, in his ground-breaking opinion legalizing same-sex marriage in all 50 states, Justice Anthony M. Kennedy began by insisting the Constitution protects the liberty of all persons "to define and express their identity."
This is especially true when it comes to a value-laden and professional practice like healthcare.
Alarmingly, this understanding of medicine is coming under tremendous pressure from what Mark Mercurio, a professor of pediatrics and ethics at Yale University's medical school, calls "the Burger King model." Instead of medicine being treated as a profession governed by internal norms and values, it's increasingly seen as market-based, with patients as customers who come in and "Have It Their Way."
This model is at the heart of those who believe Catholic hospitals ought to be forced to tie the tubes of their patients. On this view, a hospital denying someone's request for a tubal ligation would be just as strange as a Burger King denying requests for Whoppers with no onions.
But if you take a professional view of medicine, the following question must be asked: Is intentionally interfering with someone's reproductive system (in ways which do not address some injury or disease) an act of healthcare? This is a disputed question, of course, and one's answer depends on one's particular value system. From the Catholic Church's perspective, it is not.
When healthcare providers are forced by law to violate the values that make them who they are — because of the request of customers demanding goods and services in the free market — it signals the end
of medicine as a professional practice.
It makes medicine just another exchange of goods and services, and puts patients in the role of customers, ordering whatever they want from physicians. In such a world, an orthopedic surgeon would be forced to cut off a patient's perfectly healthy leg rather than insisting that his bodily integrity identity disorder be treated instead. Someone with only months to live could order a knee replacement. And nothing could stop those who are merely "tired of life" from demanding a prescription for a deadly dose of medication.
If that sounds wrong to you, then you have to say there is no justification for refusing healthcare providers — including Catholic hospitals — the freedom as professionals to determine their own answers to these vexing questions.
If instead we single out religious hospitals and deny them this freedom, it would reveal that a very serious kind of discrimination is present in our culture. And it is the kind of discrimination that not only reveals contempt for the 1st Amendment, but also for the right of all to define and express their identity.
Charles C. Camosy, an associate professor at Fordham University, specializes in bioethics and theology.