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Will the Religious Right Succeed? An Examination of the Hercules Ruling on the Birth Control Benefit

11:45 am in Uncategorized by RH Reality Check

Written by Imani Gandy for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

In May of this year, Jan Brewer signed into law Arizona HB 2625, a bill that would allow employers to opt out of the policy under the Affordable Care Act ensuring that all insurance policies cover preventive health care services for women, including contraception, without a co-pay.

It’s a simple concept, really: contraception is health care. Health insurance plans offer coverage for health care. Ergo, health insurance plans should offer coverage for contraception. Ta da!

Laws like Arizona HB 2625 undercut this simple concept. According to supporters of laws like HB 2625, contraception is of the devil. And because the Catholic Church’s official position on contraception is that it is sinful, the Church seems personally offended at the notion that any employer be required by the government to exist in the same space as women who are using their hard-earned wages to pay for contraceptive and other health care services that are anathema to church doctrine.

A couple months ago, I published a piece that described what I saw as a dangerous slippery slope regarding Arizona HB 2625 (and laws like it), which permit employers to claim some sort of religious affiliation and thus excuse themselves from providing critical health-care services to women employed by them.

In that piece (and in the lively discussion that followed in the comment section), I noted that the exemptions provided by the Arizona legislation for “religiously-affiliated employers” went far beyond the exemptions provided by the Obama Administration to religious institutions, insofar as the Arizona law permits any employer to, essentially, pinky swear that its business is steeped in Jesus.

HB 2625 provides as follows:

A RELIGIOUSLY AFFILIATED EMPLOYER MAY REQUIRE THAT THE CORPORATION PROVIDE A CONTRACT WITHOUT COVERAGE FOR SPECIFIC ITEMS OR SERVICES REQUIRED UNDER SUBSECTION YOF THIS SECTION BECAUSE PROVIDING OR PAYING FOR COVERAGE OF THE SPECIFIC ITEMS OR SERVICES IS CONTRARY TO THE RELIGIOUS BELIEFS OF THE RELIGIOUSLY AFFILIATED EMPLOYER OFFERING THE PLAN. IF A RELIGIOUSLY AFFILIATED EMPLOYER OBJECTS TO PROVIDING COVERAGE FOR SPECIFIC ITEMS OR SERVICES REQUIRED UNDER SUBSECTION Y OF THIS SECTION, A WRITTEN AFFIDAVIT SHALL BE FILED WITH THE CORPORATION STATING THE OBJECTION. ON RECEIPT OF THE AFFIDAVIT, THE CORPORATION SHALL ISSUE TO THE RELIGIOUSLY AFFILIATED EMPLOYER A CONTRACT THAT EXCLUDES COVERAGE FOR SPECIFIC ITEMS OR SERVICES REQUIRED UNDER SUBSECTION Y OF THIS SECTION.

The law defines “religiously affiliated employer” as follows:

“RELIGIOUSLY AFFILIATED EMPLOYER” MEANS EITHER:
(a) AN ENTITY FOR WHICH ALL OF THE FOLLOWING APPLY:
(i) The entity primarily employs persons who share the religious tenets of the entity. (ii) The entity primarily serves persons who share the religious tenets of the entity.
(iii) The entity is a nonprofit organization as described in section 6033(a)(2)(A)(i) or (iii) of the internal revenue code of 1986, as amended.
(b) AN ENTITY WHOSE ARTICLES OF INCORPORATION CLEARLY STATE THAT IT IS A RELIGIOUSLY MOTIVATED ORGANIZATION AND WHOSE RELIGIOUS BELIEFS ARE CENTRAL TO THE ORGANIZATION’S OPERATING PRINCIPLES.

Plainly, the limitation set forth in subsection (b) is no limitation at all. Any entity can change or amend its articles of incorporation relatively easily — it doesn’t take a lot of imagination. Indeed, when I first wrote about the Arizona law, I suggested that companies would rush to make their companies more Jesus-based in order to take advantage of religious exemptions, and to avoid being forced by Big Government to provide full health insurance coverage for women.

While my concern at the time related only to the Arizona’s contraception opt-out law, it seems that my prediction of what would soon come to pass is proving correct.

On Friday, a Colorado district court judge granted a preliminary injunction in a lawsuit brought by an air conditioning company and its owners against the Obama Administration. In the lawsuit, plaintiffs*** complain that they have “a sincere conscientious religious objection to providing coverage for abortifacients, contraception, sterilization and related education and counseling,” and that a policy requiring coverage of birth control “constitutes government-imposed coercion on Plaintiffs to change or violate their sincerely held religious beliefs.”

Here are some relevant allegations from Plaintiffs’ complaint. (Pardon the extensive quote, but it’s important to read exactly what air conditioning companies and the like are claiming about the inherent Christ-like nature of their small businesses — so read it!):

28. The Newlands are practicing and believing Catholic Christians. They strive to follow Catholic ethical beliefs and religious and moral teachings throughout their lives, including in their operation of Hercules.

29. The Newlands sincerely believe that the Catholic faith does not allow them to violate Catholic religious and moral teachings in their decisions operating Hercules Industries. They believe that according to the Catholic faith their operation of Hercules must be guided by ethical social principles and Catholic religious and moral teachings, that the adherence of their business practice according to such Catholic ethics and religious and moral teachings is a genuine calling from God, that their Catholic faith prohibits them to sever their religious beliefsfrom their daily business practice, and that their Catholic faith requires them to integrate the gifts of the spiritual life, the virtues, morals, and ethical social principles of Catholic teaching into their life and work.

30. The Catholic Church teaches that abortifacient drugs, contraception and sterilization are intrinsic evils.

31. As a matter of religious faith the Newlands believe that those Catholic teachings are among the religious ethical teachings they must follow throughout their lives including in their business practice.

32. Consequently, the Newlands believe that it would be immoral and sinful for them to intentionally participate in, pay for, facilitate, or otherwise support abortifacient drugs, contraception, sterilization, and related education and counseling, as would be required by the Mandate, through their inclusion in health insurance coverage they offer at Hercules.

33. Hercules’ mission statement includes the commitment that “We will nurture and maintain the culture of a family owned business in which our employees grow financially, intellectually, emotionally and spiritually.”

34. The Newlands have, for a substantial period of time to the present, operated Hercules in promotion of Catholic ethical principles in a variety of ways including but not limited to the structuring of their health insurance plan.

35. Under the Newlands’ direction Hercules has donated hundreds of thousands of dollars to Catholic parishes, schools, evangelical efforts, and charitable causes averaging nearly$60,000 every year since 2008.

36. Since 2010 the Newlands’ have been implementing within Hercules a program created by the Spitzer Center for Ethical Leadership, by which companies build their corporate culture based on Catholic principles. Through this program, the Newlands have regularly trained their management to implement principles based on plaintiffs’ religious ethical beliefs.

In granting the preliminary injunction, the Court had to take into consideration two factors as a matter of law. One, whether or not plaintiffs were in danger of suffering irreparable harm, and two, whether or not plaintiffs were likely to succeed on the merits of their case (in other words, whether or not the ultimate conclusion of the case would be in favor of the company and its owners.)

On both points, the Court found in plaintiffs’ favor. As to the threat of irreparable harm, plaintiffs would be required to begin providing contraception in its health plan on November 1, 2012 and were therefore in danger of suffering of irreparable harm. No surprise there. (A Nebraska district court judge recently dismissed one of these contraception opt-out lawsuits, but only did so because the Plaintiff-employer was not due to adhere to the mandate until August 2013; the court found that there was no immediate threat of irreparable harm.)

The Court’s reasoning as to the second factor — whether or not plaintiffs are likely to succeed on the merits — is what is troublesome, to put it mildly.

Plaintiffs are claiming that the contraception mandate violated their rights under the First Amendment and under the Religious Freedom and Restoration Act (RFRA). Under RFRA, the legal inquiry goes something like this:

1. When “a person refuses to provide health insurance that covers contraceptives and abortifacients, is that an “exercise of religion?”

2. Does the contraception mandate “substantially burden” such exercise of religion?

3. Does the burden of such exercise of religion further a “compelling governmental interest?”

4. Is the burden of such exercise of religion the “least restrictive means” of furthering a compelling governmental interest?

The court answered questions 1 and 2 in the affirmative, and 3 and 4 in the negative.

Now, here’s where it gets tricky.

Of course, promoting women’s public health is a compelling governmental interest, and the Court noted as much. But RFRA requires an examination of the burden as it relates to the actual person being burdened (or to the corporation being burdened, as the case may be — corporations are people, my friend!). Just because the mandate burdens all similarly-situated parties doesn’t mean that it is constitutional as applied to Plaintiffs specifically. The government must demonstrate that burdening Plaintiffs furthers a compelling interest.

And this is where the problem arises: How can the government demonstrate that burdening Plaintiffs furthers a compelling interest when it exempted 190 million health plans from complying with the contraception mandate? An even more difficult question is this: If providing preventive health care to women and doing so by uniformly applying this mandate to all employers irrespective of religious background is so compelling, then why exempt so many health plans?

From a legal standpoint, the Obama Administration may have difficulty answering those questions. Certainly, the Administration’s actions make sense from a political standpoint. Given the fact that the Catholic Church has its fingers in our contraceptive pie, the Administration had to work with the Bishops or risk having the whole deal fall apart. (It seems to be falling apart anyway; the Catholic Health Association reneged on their initial agreement that the mandate as revised by the Administration was suitable.) In other words, by working with the Catholic Church in order to craft this mandate in such a way that the Catholic Church would not bitch about it, the Obama Administration may have shot itself in the foot, because guess what? The Catholic Church is bitching about it.

Ultimately, pointing out that the 190 million exempted plans undercuts the notion that the mandate is necessary and must be uniformly applied is a good tactic on the part of contraception mandate opponents. It forms the basis of a solid legal argument, I think. The only counter-argument that currently comes to mind is that the compromises that the Obama Administration made with religious organizations, and the exemptions provided to them were necessary as a practical matter in order to pass the legislation in the first place. In other words, the interest being served by this legislation is so compelling that undercutting it slightly in order to promulgate it was warranted.

Right.

Doesn’t sound like as solid of an argument, does it?

As to the whether or not the contraception mandate is the “least restrictive” means of furthering the “compelling governmental interest”  – as in “ensuring that women have access to preventive care including contraception” — the Court said it wasn’t.

The Court found that less restrictive means existed; for example, government-provided contraception would ensure that women have access to contraception and would not substantially burden Plaintiffs’ exercise of religion. (At least until the Catholic Church decides that merely being governed by an institution ensuring access for sluts to contraception without a co-pay is an “intrinsic evil.”)

Obviously, the political landscape is such that any sort of socialized women’s healthcare is a pipe dream. Wingnuts are already losing their collective shit because they think women are currently demanding that the government provide free contraception: “Why should I have to pay for you to have sex!” (Of course, women simply want coverage for contraception in health plans that they pay into but don’t try to argue against conservafacts — you’ll just go mad.)

Imagine the outcry if government-provided birth control became an Obama Administration policy goal because contraception access was stymied by religious zealots whining about freedom of religion for themselves (and their corporations.)  “Obama is a pimp!” I can hear it already. 

These are the sorts of legal arguments that we are going to be seeing. Corporations will claim that they are people and therefore entitled to the same First Amendment rights to freedom of religion that actual living breathing people do. Corporations will claim that they are “person[s]” to which RFRA applies. Meanwhile actual persons are going to continue to be stripped of their rights as persons.

*** Notably, the preliminary injunction was granted to plaintiffs. Plaintiffs in the case are the air conditioning company and the owners of that company. Whether or not a corporation’s free exercise of religion is now a right that must be protected is a subject for another post, the mere thought of which causes me great distress.

[You can read my mark-up of the Court's order here on Scribd]

Anti-Choice Medical Malpractice Shields Threaten to Permanently Alter Medical Care for Women

9:51 am in Uncategorized by RH Reality Check

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Written by Jessica Mason Pieklo for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Among the new restrictions appearing in anti-abortion bills nationwide, it is the medical malpractice liability shields that have the potential to alter, perhaps permanently, women’s relationship with the civil justice system.

Both Kansas and Arizona are advancing measures that exempt doctors from medical malpractice suits should they withhold medical information in order to prevent a woman from having an abortion. These bills also shield doctors from malpractice claims if a woman suffers an injury from a pregnancy as a result of information withheld from her to prevent an abortion. Georgia just snuck a liability shield into their 20-week abortion ban. We can expect more to follow.

Proponents of these “wrongful birth” bills argue they are necessary to stem the tide of lawsuits like one in Oregon where parents sued for costs related to the care of their daughter who was born with Down Syndrome. In that case the parents argued that the medical professionals were negligent in conducting the genetic testing and had they known their daughter would be born with a disability they would have had an abortion.

This is the kind of case that is destined to generate lots of headlines and some terrible legislation in its wake. In reality, less than half the states recognize a claim for wrongful birth and in those states that do, cases like this one are rare and these kinds of verdicts ever rarer. Nevertheless, anti-choice activists see an opening, and they are going to take it.

So far neither Kansas, Arizona, or Georgia has yet signed into law these malpractice shields. But assuming they do, the impact on medical malpractice law and the ability of women to justly compensated should they be the victim of sub-standard medical care cannot be overstated.

In order to successfully prosecute a claim for medical malpractice a plaintiff needs to prove that a medical professional violated the standard of care in delivering medical advice or care. This is no easy task. Determining what the standard of care is requires an objective look at the standard practices of similar professionals in similar situations and comparing that the the care delivered in the specific case at hand. Expert testimony is almost always required as other medical professional opine as to what course of treatment and advice was indicated given the specifics of a patient’s case.

The standard of care is considered, roughly in legal standards, to be the average care a patient can expect to receive. The care doesn’t need to exceed this standard but it can’t slip below it without it being considered negligence and doctors and hospitals being held liable for any injuries that come from that negligence.

Wrongful birth bills change all this. With these provisions dictating a specific course of treatment in the case of withholding information to drive a particular medical outcome the standard of care is essentially set by legislators. Say goodbye to a community of medical professionals determining best medical practices.

In practice this means that instead of an objective inquiry into the medical treatment and advice given to a pregnant woman based on what the profession as a whole considers competent medical treatment, the individual beliefs of the doctor will determine if advice given or care rendered was reasonable. In legal terms that changes the inquiry from objective to subjective meaning there is no real basis to judge conduct against. It will no longer matter what a doctor’s peers believe to be considered good medical care: it will only matter if that particular doctor thought the care would avoid an abortion.

Furthermore, that inquiry won’t be focused on advice given or care rendered in the scope of protecting the health and life of the mother, but instead on decisions and care motivated solely to perpetuate a pregnancy. This erases the mother as primary patient to at best, a secondary consideration. What the medical community considers to be competent advice and care will cease to be relevant as the only concern will be did this individual doctor make this individual decision based on his or her individual desire to prevent an abortion. In no other area of tort law do we allow this. And for good reason.

That’s because tort law is designed to compensate victims in the case of others negligence. These malpractice shields presume that withholding information from patients to impact a decision regarding care is an act of negligence. The bill itself proves the point. If providing medical advice based on personal moral beliefs instead of medically evidenced-based indicia was not considered medical malpractice shielding doctors from malpractice would be unnecessary.

The impacts on patient care will also be long-term. One of the effects of tort reform–and these malpractice shields are another form of tort reform– is to weed out dangerous and ineffective medical practices. Instead of providing women with all information necessary so they can make an informed medical decision the standard of care will be to make that decision for them, no matter what that decision happens to be. That means the persuasive force of tort reform will no longer exist in regards to reproductive health care in these states. In fact, these bills could have the opposite effect as the aspect of community review that takes place in determining a standard of care will become irrelevant. Bad doctors will be permitted to continue practicing bad medicine with no consequences, nor any threat of consequences.

That also means that women in states with wrongful birth bills can never be sure the medical information they are receiving is accurate and unbiased, nor can they sue in the event that its wrong or negligent. And that women in states without these bills will have to exercise even more caution and be even greater advocates for their own care as what constitutes good accepted medical practice is no longer easily determinable.

Pregnant women will, in effect be returned to the same legal standing of juveniles or persons under legal guardianship and conservatorship, devoid of the ability to consent to a full course of medical treatment on their own.

The impact of these bills will also reach far beyond just abortion politics. Birth injury cases represent a significant portion of medical malpractice cases in general, in large part because the costs associated with an act of negligence in pregnancy and delivery are so great. Insurance companies generally (and usually successfully) fight coverage for those costs meaning that malpractice recoveries often represent the only financial means of providing for a disabled child. These wrongful birth bills will allow those claims to go uncompensated as all health care professionals need to do to avoid liability in any case is to justify their course of treatment in terms of seeking to prevent an abortion.

The creation of a medical malpractice shield simply strips women of the ability to be compensated for sub-standard medical care rendered to them while pregnant and nothing more.

Couple wrongful birth bills with the federal medical malpractice bill that just passed the House of Representatives and it becomes clear that this push to strip women of the ability to challenge substandard medical care they receive is seen as the solution to that pesky legal reality that women’s bodies receive any legal protections to begin with. And since medical malpractice claims are always claims for money damages, there is no more straightforward a way to say that women’s lives have no value then to take away their ability to bring a claim based on the value of that life to begin with.

Report: States Pass Staggering Array of Anti-Choice Laws, Policies and Ballot Measures

6:43 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Live in Tennessee, Mississippi, Arizona, Missouri or Louisiana? The Center for Reproductive Rights (CRR) wants you to know that, with the implementation of health care reform in 2014, you will not have access to abortion coverage in your state’s health exchanges. These states have enacted insurance bans on abortion coverage. Five other states considered the bans and the CRR expects more to do so in 2011. But this is only the tip of the iceberg. The 2010 state legislative session has seen legislation forcing women to undergo "biased counseling" (and compelling health care providers to provide said counseling) which may contain medically inaccurate and misleading information, as well as mandatory ultrasound requirements. Some states have pushed anti-provider bills which seek to bar physicians who provide abortion care from a state’s malpractice compensation fund, and bills which force women to return at least twice to a provider before being deemed acceptable to have a legal abortion. States have sought to define zygotes and fertilized eggs as people; and punish women by barring any insurance coverage for abortion – even if the woman became pregnant as a result of rape.

The Center for Reproductive Rights (CRR) recently released its summary on the "major trends in anti-abortion legislation that emerged this year and of the onerous abortion restrictions enacted," according to a statement from the organization.  "A First Look Back at the 2010 State Legislative Session," (PDF) details alarming trends among the states to severely restrict access to legal abortion care.

Of particular consequence this past year has been the Nelson Amendment to the health care reform bill, which is responsible for the ban on abortion coverage in the health exchanges. As mentioned above, in response to the provision, five states have already passed similar state bans with more expected. CRR notes that anti-choice proponents’ argument over abortion access in federal health care reform efforts focused on outright false information about the importance of abortion access, as health care, for women in this country.  . . . Read the rest of this entry →

USCCB Clarifies: Only Some Lives Worth Saving

7:55 am in Uncategorized by RH Reality Check

Written by Kathleen Reeves for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

In the wake of the "automatic excommunication” of Sister Margaret McBride, a nun who was part of a committee that granted an abortion to a woman whose pregnancy threatened her life, theologians are splitting hairs over excommunication, intention, and conscience. In order to clear things up, the U.S. Conference of Catholic Bishops has released a statement articulating the difference between “direct” and “indirect” abortion.

Direct abortion is a “procedure whose sole immediate effect is the termination of pregnancy,” including when the mother’s life is in danger.

Of course, there’s another effect, which is that the mother’s life is saved. Perhaps it’s not immediate enough?

Indirect abortion happens as follows:

"Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman” that “cannot be safely postponed until the unborn child is viable” and may “result in the death of the unborn child.”

The second is okay by the Church; the first, no.

Are you confused? If so, it’s because there is NO SUBSTANTIVE DIFFERENCE between these two scenarios. In order for a woman to live, her pregnancy must end.

The USCCB’s Committee on Doctrine provides these helpful examples:

The first involves a pregnant woman who is experiencing problems with one or more of her organs, apparently because of the added burden of pregnancy. In this case, the doctor recommends an abortion to protect the woman’s health.

In the second example, a pregnant woman develops cancer in her uterus. In this case, the doctor recommends surgery to remove the cancerous uterus as the only way to prevent the cancer from spreading. Removing the uterus also will result in the death of the unborn child.

The only difference I see in these cases is that in case two, the fetus is hidden away in the uterus, so the doctors removing it can pretend it’s not there.

And thus it is that a rich theological tradition is reduced to garbage. And unfortunately, this reasoning, reminiscent of “How many angels can dance on the head of a pin?,” is medical policy.

The USCCB has not had a good year. But, as Nicholas Kristof pointed out, at least it didn’t have to excommunicate any child molesters.

Diocese of Phoenix Maligns Nun, Errs on Canon Law

6:54 am in Uncategorized by RH Reality Check

Written by Jon O’Brien for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

The recent news about a woman in Phoenix who received an abortion in a Catholic hospital has raised again the issue of Catholics, abortion and excommunication.

The bishop of Phoenix has declared that a nun who is a hospital administrator and a member of the ethics committee is excommunicated because of her alleged action, or inaction, in regard to the pregnant woman’s care.

To defend the bishop’s announcement that Sister McBride was “automatically excommunicated” for her actions, the diocese has published a document called “Questions & Answers Re: The Situation at St. Joseph’s.” While the questions are timely, the answers unfortunately misrepresent the church’s law.

For example, one of questions reads: “Does that mean that all women who have had an abortion are excommunicated?” The incorrect answer the diocese provides reads: “Yes, anyone who has had an abortion is automatically excommunicated. But so are those who encouraged the abortion, helped to pay for the abortion, or performed the abortion, including those who directly assisted in its performance.” This claim is simply not supported by Catholic canon law.

The real answer to that question is: No. Not every woman who has an abortion is excommunicated. The Catholic church’s law on crimes and punishments is very strict, and, as in secular criminal law, provides a range of characteristics that would make a person incapable of committing a crime (for example, being under the age of seventeen, or acting in self-defense). There are also mitigating factors that would make a person who committed a crime ineligible for punishment or eligible only for a lesser penalty. These include people who act in fear or in case of necessity.

Another wrong answer is provided in response to this question: “From the news reports we were told that Sr. McBride also consulted with others who agreed that the abortion should be performed. Are they also excommunicated?” The diocese says: “Yes. Those Catholics who gave their consent and encouraged this abortion were also excommunicated by that very action. So too is anyone else at St. Joseph’s who participated in the action; including doctors and nurses.”

The real answer is, again: No. The Catholic church’s law does, in limited circumstances, provide penalties for accomplices, but the scope of people who might be eligible is even smaller than in the first case. In the situation at St. Joseph’s, even if all the requirements were met, the penalty of excommunication would only be available for someone whose participation was so necessary that the abortion would not have been provided without his or her action. It’s not clear that this is the case for Sr. McBride. Canon lawyers have long agreed that the actions of hospital administrators rarely if ever rise to the level that would consider them “accomplices” according to canon law.

It is unfortunate that once again, given an opportunity to show compassion and understanding, the Catholic hierarchy has instead taken the low road and persecuted a Catholic who, in good conscience and based on her experience, provided her opinion in a difficult medical and ethical situation. The bishop’s response was to publicly damage the good reputation of a woman who has, by all accounts, dedicated much of her life to caring for those in need. In the Catholic church, Sister McBride has a right to her good reputation and a right, as well as a duty, to follow her conscience. It’s notable that the diocese isn’t talking much about those provisions of canon law.

Arizona’s Immigration Policies: Racism and Collective Hypocrisy

8:13 am in Uncategorized by RH Reality Check

Written by Aziza Ahmed for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Arizona’s Governor Brewer is on a roll with anti-immigrant law-making. Under S.B. 1070 racial profiling may worsen (or be more easily justified) and with H.B. 2281 schools could justify not teaching students about a variety of historical injustices if these lessons could be understood to “promote resentment” towards a particular race or class. Not only are the courses under attack, but the teachers as well: the Arizona Department of Education has begun a process to remove teachers with accents from classrooms.  

Hatred towards immigrants is masked in a variety of discourses: “national security”,  “border security”, “high unemployment”, or if you are Pat Buchanan it is disguised in the subtle subtitle of your book “State of Emergency: the Third World Invasion and Conquest of America.”  Okay, so maybe it is not hidden at all.  In fact, alongside the current debates in Arizona, one of the more obvious examples of our disregard for immigrants (particularly undocumented immigrants) was President Obama’s health care reform speech of September 2009. It was at the precise moment President Obama was reassuring us that undocumented immigrants would be left without healthcare that Representative Wilson shouted, “You lie!”  And then everyone got mad.  For good reason of course, because aside from Representative Wilson’s outlandish and disrespectful behavior – Obama was telling the truth: we had all agreed to deny undocumented immigrants healthcare.

Of course, this anti-immigrant sentiment emanates from all sides of the debate and manifests in horrific ways for many.  Take for example the shocking case of Miriam Mendiola-Martinez shackled to her hospital bed after giving birth because she was undocumented and in police custody. Amnesty International has documented the impact of racism on immigrant women negatively affecting safe childbirth and delivery.  In addition to racism, a fear of authorities, an inability to speak English, and inability to navigate the health care system by immigrants also served to lessen women’s abilities to receive adequate health careIn 2003 the Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care highlighted discrimination as a key factor in racial and ethnic health disparities.

Who is Governor Brewer’s staunchest supporter in this anti-immigrant frenzy? None other than Sarah Palin –this time attacking immigrants only a few short months after admitting to crossing the border into Canada for health care.  Brewer and Palin even have a website which offers oddly pieced together facts and statistics alongside a seemingly amateur YouTube video about the need for border security.  Their law, the website proclaims, is being misrepresented and unfairly attacked.  However, while Arizona’s laws are rightly under fire for their racist underpinnings, there seems to be a convenient collective amnesia on the side of those claiming a moral upper hand in this argument (the less racist hand, the more accepting hand).  After all, didn’t everyone just finish agreeing (compromising) that there are some things that immigrants, especially undocumented immigrants, just shouldn’t have some of – like healthcare?

It’s possible that at the end of this odd debate consisting of forgotten hypocrisy and poorly made websites helpful information may emerge.  I mean, maybe Sarah Palin has some tips on getting the more than 11 million undocumented people that have little to no healthcare access in the United States into Canada legally for healthcare?  It was her own family’s solution after all. Perhaps that’s a project for the Brewer-Palin amateur video production team?  I bet that one would go viral.

 

Are Catholic Hospitals Safe for Pregnant Women?

6:33 am in Uncategorized by RH Reality Check

The news of the excommunication of Sister Margaret McBride, the nun at a St. Joseph’s Hospital and Medical Center in Phoenix who approved an abortion that was necessary to save the life of a woman, has shocked and angered both the devout and the non-religious alike. 

Catholics for Choice condemned the action via press release, stating:

"[I]t is clear that the Vatican’s hard line on abortion led to this terrible situation. Sadly, we see situations like this time after time, both here in the US and abroad. The Vatican’s outright ban on all abortions is insensitive and reflects an unwillingness to acknowledge the reality of women’s lives, including the difficult decisions that often have to be made during a pregnancy.

Reasonable Catholics the world over acknowledge that access to abortion is sometimes necessary, and our polling and that of other organizations shows that a large majority of Catholics reject the Vatican’s outright ban on all abortions."

Reasonable Catholics may very well reject the outright ban on abortion, but it seems that these are not the Catholics who often get to make the final decision on medical procedures that occur within hospital walls.  Because, unfortunately, situations like the one in the Arizona hospital occur with great frequency, and women’s lives and medical requests are often ignored in the name of religious doctrine.

Earlier this month the Journal of General Internal Medicine released a study showing how rampant the disagreement is between Catholic hospitals and the doctors who provide care for patients.  From the American Medical News Association:

Most of the physicians reporting conflicts worked in Catholic hospitals, which account for 12.5% of all U.S. community-based hospitals and 15.5% of hospital admissions, according to the Catholic Health Assn. of the United States.

Catholic hospitals are required to follow the U.S. Conference of Catholic Bishops’ religious directives on medical care that bar contraception, abortion and sterilization and, in many instances, rule out ending artificial hydration and nutrition.

When conflicts arise, 86% of surveyed physicians said they would encourage patients to seek the recommended care at another hospital. Ten percent said they would offer an alternative treatment that could be delivered at the religious hospital, and 4% endorsed violating the hospital’s policy to provide the care.

The author of the study, Dr. Debra Stulberg, has had her own issues with medical directives being overturned by Catholic hospital administrators, and in one case a woman would have been forced to put her life in danger just to avoid abortion.

Family physician Debra Stulberg, M.D., was completing her residency in 2004 when West Suburban Medical Center in Oak Park, Illinois, was acquired by the large Catholic system Resurrection Health Care. "They assured us that patient care would be unaffected," Dr. Stulberg says. "But then I got to see the reality." The doctor was struck by the hoops women had to jump through to get basic care. "One of my patients was a mother of four who had wanted a tubal ligation at delivery but was turned down," she says. "When I saw her not long afterward, she was pregnant with unwanted twins."

And in emergency scenarios, Dr. Stulberg says, the newly merged hospital did not offer standard-of-care treatments. In one case that made the local paper, a patient came in with an ectopic pregnancy: an embryo had implanted in her fallopian tube. Such an embryo has zero chance of survival and is a serious threat to the mother, as its growth can rupture the tube. The more invasive way to treat an ectopic is to surgically remove the tube. An alternative, generally less risky way is to administer methotrexate, a drug also used for cancer. It dissolves the pregnancy but spares the tube, preserving the women’s fertility. "The doctor thought the noninvasive treatment was best," Dr. Stulberg recounts. But Catholic directives specify that even in an ectopic pregnancy, doctors cannot perform "a direct abortion"—which, the on-call ob/gyn reasoned, would nix the drug option. (Surgery, on the other hand, could be considered a lifesaving measure that indirectly kills the embryo, and may be permitted.) The doctor didn’t wait to take it up with the hospital’s ethical committee; she told the patient to check out and head to another ER.

Waiting for the ethical committee to approve would not only delay the patient’s care and put her life in danger, it still couldn’t guarantee a positive outcome for the patient.  After all, it was Sister Margaret McBride’s ruling on the committee in favor of saving the mother’s life in Arizona that got her excommunicated.  How many members of the church are willing to risk what they believe to be their immortal souls to defy the church, even if it means saving a woman’s life?

And truly, many of these are cases of saving a woman’s life.  Women who are already in danger due to their pre-existing conditions are being told that not only are they so expendable, and that these hospitals will not perform the abortions that would save their lives, but that they should further risk their lives by seeking out some other place that might provide them care, such as Michelle Lee, who had to travel to a different state to have a necessary procedure performed.

In 1998, the Louisiana State University Medical Center in Shreveport refused to provide an abortion for Michelle Lee, a woman with cardiomyopathy who was on the waiting list for a heart transplant, despite her cardiologist’s warning that the pregnancy might kill her. Hospital policy dictated that to qualify for an abortion, a woman’s risk of dying had to be greater than 50 percent if her pregnancy was carried to term; a committee of physicians ruled that Lee did not meet this criterion. Since her cardiomyopathy made an outpatient abortion too dangerous, she traveled 100 miles to Texas by ambulance to have her pregnancy terminated.

The woman’s risk of dying has to be greater than 50 percent.  And even then, who gets to determine if her risk is above 50 percent, if the doctors are being overruled by the Catholic hospital administrators?  As Dr. Debra Stulberg’s attending put it to her, "So, it looks like we’re going to be working for the Pope."

Do you want the Pope deciding on your medical care?