The nation's Roman Catholic bishops firmly declared Friday that sterilization is "intrinsically evil" and will no longer be permitted at Catholic-affiliated hospitals.
The ethical and religious directives were prompted by Vatican objections to what were seen as loopholes in cooperative agreements with the many non-Catholic hospitals that have been purchased by Catholic health care chains.
The rules put sterilization, including tubal ligation, on the same footing with abortion and euthanasia, both of which have long been condemned by the church.
"This leaves no wiggle room," Bishop Joseph A. Galante of Beaumont, Texas, said during Friday's floor debate.
The bishops' 209-7 vote prohibiting hospital sterilizations comes at a time when Catholic hospital chains are expanding across the country, in large part by buying former non-Catholic institutions or by entering into joint operating agreements.
In many cases, merging with a Catholic organization has saved financially strapped hospitals from closing. But it has also meant new restrictions on such medical procedures as abortion.
The greatest effect of the bishops' decision, made during a meeting of the National Conference of Catholic Bishops, is expected to be felt most in rural areas where hospital choices are limited. But critics were also troubled by the sheer reach of the policy: It covers 620, or 11%, of all hospitals in the country.
The new rules apply not only to Catholic facilities, which have not offered sterilization services, but to non-Catholic hospitals that are owned in whole or in part by Catholic chains.
"I don't care what they impose on Catholics. I do care what they impose on the rest of society," said Stanley Korenman, professor of medicine and associate dean of ethics at UCLA. "They are showing a striking disregard for the ethics of the rest of society.
"In lots of places, the Catholic hospital is the hospital. [They] are denying people who are not Catholics in that community the opportunity to have surgical sterilization, which is legal and accepted."
Fred Caesar of the Catholic Hospital Assn. said it did not keep records of how many non-Catholic hospitals were affiliated with Catholic hospitals, but a statement by the group Friday said there had been about 150 mergers, joint operating agreements or shared services.
In the past, non-Catholic hospitals affiliated with the church have been able to get around the church's prohibitions against abortion and sterilization by creating a legally separate entity within the hospital.
For example, when Leila Hospital in Battle Creek, Mich., became part of the Catholic Battle Creek Health System, it was able to continue offering sterilization services through a legal device by which four beds in the hospital were ceded to a legally separate "condominium hospital," with its own operating room and governing board.
But Archbishop Daniel E. Pilarczyk of Cincinnati, who headed the committee that drafted the tougher standards, told reporters Friday that such arrangements would no longer be allowed.
"If the practices are not in accord with the ethical directive, I expect those practices will change." He said the Vatican found some existing contracts to be "unsatisfactory." What was at stake, he said, was "the whole gambit of Catholic respect for life."
In Friday's debate, Bishop Raymond L. Burke of La Crosse, Wis., said cooperative practices in the past had led to confusion. "From my own experience, this must be addressed clearly now lest the confusion of the last decades continue and do a grave moral harm."
Women's rights groups and abortion rights supporters condemned the new directive. "It's simply devastating for women," said Susan Fogel, legal director of the California Women's Law Center in Los Angeles.
"It's frankly unconscionable that they would be able to impose their own religious beliefs on the health care that men and women in this country can get."
Fogel noted that some non-Catholic hospitals agreed to merge only after assurances that reproductive health services would continue to be available. She said the law center would closely follow developments and determine whether hospitals continue to live up to contract commitments.
One survey taken last year found that 28% of contraceptive users of childbearing age chose tubal ligation, also known as female sterilization. That proportion rose to 41% among the poor. It is the only form of contraception difficult to provide outside of a hospital setting. (The new policy will have little effect on abortions or vasectomies because they are usually performed in doctors' offices, not hospitals.)
Jon O'Brien, vice president of Catholics for a Free Choice, an unofficial group often at odds with the Vatican, said the bishops' action may throw into doubt existing contracts between non-Catholic and Catholic hospitals, and future mergers. "This vote damages the credibility of the Catholic hospital as a negotiating partner," he said.
But the Rev. Michael D. Place, president and chief executive officer of Catholic Health Assn., said the revised ethical guidelines are intended to "maintain appropriate distance" between prohibited procedures in the areas of governance, management and financial benefit.
Forty-nine California hospitals are Catholic-owned. An additional 17 in the state are affiliated with the church, according to the Alliance of Catholic Health Care. In Los Angeles County, 25% of acute-care hospital beds are in nonsecular hospitals, all but two of them Catholic. Eight of the nation's 14 largest health care systems are Catholic.
In other actions Friday, the bishop conference unanimously declared that the United States bears "special responsibility" to combat global warming. Bishops urged policymakers, including President Bush, to act now to avert consequences that they said could jeopardize future generations and the planet.
The statement comes as Bush is under criticism during a European trip for opposing the Kyoto protocol, a climate change treaty signed by former President Clinton but never ratified by the U.S. Senate.
While the bishops took no stand on the Kyoto protocol--a treaty setting specific targets for reducing so-called greenhouse gases--they made it clear that prudence alone demands action. Last Monday, Bush called for more studies and monitoring of climate change but offered no specific actions to reduce greenhouse gases.
Cardinal Roger M. Mahony of Los Angeles was chairman of the bishops' Domestic Policy Committee, which drafted the climate change statement after three years of closed hearings and study.
Asked whether he was disappointed in Bush's failure to endorse specific action steps, Mahony said: "I'll put it this way. I think the president is in a great position to give national and international leadership on this issue, and I hope our statement will help him see that a bit more clearly."
In another matter, the bishops accepted guidelines for implementing a plan approved in 1999 that requires Catholic theologians at Catholic universities and colleges to obtain a certification--known as a mandatum--from their local bishop that attests that they hew to official Catholic dogma and moral teaching.
While some theologians and Catholic educators had warned in past years that such certification would impinge on academic freedom, bishops said Friday that in practice there is no way they can force theologians to either apply for the certification or require colleges to require certification.
"We cannot force people to do this, and if people don't do it, it seems to me they should be open to persuasion, but there is no mechanism to make anybody do anything," said Pilarczyk, who headed the committee that developed the implementation guidelines.
In 1990, Pope John Paul II ordered the church to take steps to ensure that Catholic colleges and universities maintain their distinctively Catholic character. But the Vatican left it up to national bishop conferences to put his edict into effect.
An attempt in 1996 by U.S. bishops to implement the plan was rejected by the Vatican as unacceptable. In 1999, the bishops approved a rewritten version, which was accepted by the Vatican.
Times staff writer Nedra Rhone contributed to this story.