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New Developments on Stories Featured in Catholic World Report
Limits on cooperation
Catholic hospitals will wrestle with Bishops’ directives
Bishops in the United States have placed limits on the arguments that can be used by Catholic health-care professionals to justify cooperation in sterilization and other procedures the Church considers immoral. But it remains unclear how the new guidelines will affect Catholic hospitals.
Under pressure from the Vatican, the newly renamed United States Conference of Catholic Bishops voted in June to bar “immediate material cooperation” in sterilization procedures. (Immediate material cooperation refers to a situation in which a person cooperates directly with an evil although he does not intend it to occur.) "Catholic health-care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide, and direct sterilization," states the new version of the bishops' Ethical and Religious Directives for Catholic Health Care Services, the first update of the document since 1994.
Archbishop Daniel Pilarczyk of Cincinnati, the chairman of the US bishops' Ad Hoc Committee on Health Care, acknowledged in an interview that some Catholic-run hospitals have been cooperating closely with sterilizations. “Will that change? I hope so,” he said.
Although it is clear that the new directives limit what one bishop called "wiggle room" for Catholic hospital administrators, it is impossible to predict exactly how they will affect Catholic health-care providers, according to Father Michael Place, president and chief executive officer of the Catholic Health Association. One reason is that each hospital agreement must be judged on how closely the Catholic entity is involved with providing sterilizations. “Without knowing the details of each arrangement, you really don’t know if there’s adequate distance,” Father Place said.
Moreover, even if a bishop determines that an existing agreement does not pass muster, that finding in itself triggers what Father Place calls a "now what?" analysis, because it requires another layer of moral discernment to determine what should be done about it. For instance, he said, if the Catholic institution is bound by an agreement that contains no exit clause—or, on the other extreme, if an agreement is due to expire soon—the bishop may face a complicated set of options.
Doing good, avoiding evil
The Church prohibits Catholic hospitals from offering tubal ligations, which make a woman incapable of conceiving a baby. (The Church also bars vasectomies for men, on the same grounds, but in the US those operations are usually done in clinics rather than hospitals.) But the moral issues become murkier when Catholic hospitals form partnerships with non-Catholic institutions, or when large Catholic health-care organizations take over the administration of secular hospitals. Catholic hospitals are not allowed to associate with abortion at all, but some Catholic theologians have argued that they may cooperate with sterilizations under "duress."
The plea of "duress" has furnished a tempting argument for many Catholic hospital administrators, who have seen the financial viability of their institutions threatened by recent economic trends. Rising costs have caused many formerly independent hospitals to merge or form alliances with other hospitals or with large health-care networks. Some of these alliances have brought together a mix of Catholic and non-Catholic hospitals, posing some difficult decisions for administrators who try to follow Church teaching while introducing new business arrangements.
To test those arrangements, Catholic ethicists consider the moral principles regarding cooperation. Under certain circumstances, the Church may allow cooperating with evil in order to prevent a greater evil from occurring. In recent years, some theologians have applied the principle to institutions, and particularly to Catholic health organizations. While the Vatican has made it clear that a Catholic hospital may not itself offer procedures that the Church condemns (such as abortion and sterilization), the question of whether a Catholic health-care organization can form a partnership with another hospital that provides sterilizations is more complicated.
Some theologians have argued that if a Catholic health-care organization is under duress—if its administrators think it could go out of business otherwise, for instance—it may cooperate closely with sterilizations, as long as the hospital administrators themselves do not intend for the sterilizations to occur. Using that theory as their justification, some Catholic institutions have made alliances with non-Catholic hospitals that provide tubal ligations
The new Ethical and Religious Directives reject close cooperation with sterilization: so-called "immediate" material cooperation, in which the outcome is predictable and the cooperation directly helps to bring it about. The directives also call on bishops to consider the possibility that even an otherwise justifiable association with immoral acts should be rejected because it might cause confusion about Church teachings.
Future decisions
While Father Place would not make any predictions, another observer said he is worried about the document's effect on Catholic hospitals. "It could close some down," said Msgr. William Broussard, who retired in February as executive director of the Texas Conference of Catholic Health Facilities.
Msgr. Broussard said he was not disappointed with the substance of the new version of the Ethical and Religious Directives, but rather with the timing of the bishops' pronouncements, and the apparent inconsistency between this document and previous versions. He observed that Catholic hospitals have based their policies on past statements from the US bishops dating back to the 1970s, which seemed to allow the arrangements many have now formed. "Had the bishops done this in 1975, at least Catholic hospitals would have known what was going on," Msgr. Broussard reasoned. "But that's not what they issued in 1975. They issued something completely different—put everybody between a rock and a hard place."
Other observers contend that the bishops' new directives do not go far enough in preventing Catholic institutions from becoming tainted by involvement in immoral acts. The directives are silent, for instance, on “mediate material cooperation,” a term that implies a more remote or indirect relation with the perceived evil act than immediate material cooperation. The new text also eliminates an Appendix that appeared in earlier versions of the Ethical and Religious Directives, sketching out the moral principles regarding cooperation. Archbishop Pilarczyk said he thinks Vatican officials thought the Appendix was too easy to misinterpret.
However, the bishops opted not to replace the Appendix with a strongly worded draft that had been proposed by a working group last September. That draft would have explicitly barred Catholic institutions from appealing to the principle of material cooperation.
Lawrence J. Welch, a professor of systematic theology at Kenrick School of Theology in St. Louis, said the draft would have greatly improved the Ethical and Religious Directives. “My fear is that the bishops will have to come back soon, go back and tighten things up further. And one reason is, there isn’t an authoritative statement on the principles of cooperation,” Welch said. “In my judgment, [the directives] are still capable of misinterpretation with regard to mediate material cooperation."
Early returns
Because of the complex nature of business arrangements among health-care agencies, the final results of the bishops' new directives may not be visible for some time. But a few Catholic health-care officials are already responding to the policy changes.
In Austin, Texas, Seton Healthcare Network and the city of Austin are negotiating changes to a lease agreement that Seton entered into several years ago to run Brackenridge Hospital, which was formerly run by the city. Now, the city owns the building and Seton runs the hospital, except for a small portion where the city arranges for an outside provider to perform tubal ligations. That arrangement—which was approved by the former bishop of Austin but criticized by the Vatican—is apparently due for alterations. According to a statement that the city and Seton released after the bishops changed the Ethical and Religious Directives in June:
The directives prohibit the provision of certain reproductive procedures in facilities managed by Seton, including Brackenridge Hospital. Currently, those procedures are provided on the Brackenridge campus but not by Seton Healthcare Network employees.
A public hearing in Austin was scheduled for July 18 to discuss the details of the proposed changes in the lease.
But on the Pacific coast, Catholic Healthcare West planned no changes to its current system of running some hospitals as non-Catholic “community hospitals” where sterilizations are performed. Catholic Healthcare West runs 47 hospitals, most of them in California. It operates 30 as avowedly Catholic hospitals, which do not offer procedures the Church condemns, and 17 "community hospitals," which it defines as non-Catholic. By agreement with Catholic Healthcare West, those community hospitals cannot offer abortion, but most offer tubal ligations.
"We really are not anticipating any immediate changes," says Bernita McTernan, senior vice president of sponsorship and mission at Catholic Healthcare West. "We are in compliance with the draft."
After the US bishops passed the new draft of the Ethical and Religious Directives, a June 21 story by Lisa Millegan in the Modesto Bee quoted a spokesman for a California hospital run by Catholic Healthcare West as saying: "We will continue to offer a full range of women's health services." The story continued: "Her statement seems to contradict the US bishops' strongly worded directive."
(McTernan, asked by CWR how Catholic Healthcare West's arrangements with community hospitals comply with the directives’ ban on immediate material cooperation with sterilization, referred questions to the organization's ethicist, who referred questions to an ethicist for the Diocese of Sacramento, who was on vacation when CWR went to press and could not be reached for comment.)
Leaving details aside, McTernan said that all the bishops in the dioceses where the organization runs community hospitals have given their assent to the arrangements, even since the new version of the Ethical and Religious Directives took effect. "Fortunately, we've been able to have some really good discussions with the bishops," she said.
Archbishop Pilarczyk declined to comment on Catholic Healthcare West or any other specific cases. But when asked as a general principle about a situation where a Catholic health-care organization runs certain hospitals as non-Catholic, and those hospitals provide sterilizations, the archbishop responded: “Theoretically speaking, that is somewhat disturbing.”
Archbishop Pilarczyk said that in Cincinnati he requires health-care administrators requesting approval for a merger to provide him with theological analyses from at least two Catholic moralists, before he will consider the deal himself. “If I’m going to have to give some kind of approval, I want to make sure I can live with it,” he said.
McTernan argued that Catholic Healthcare West has complied with the Ethical and Religious Directives all along. She also noted that although sterilization is the issue most often raised by reporters, that question represents only one theme of the bishops' policy statement; she calls attention to other portions of the document, which expound on the Church's philosophy of health care as an opportunity to serve those in need. "I just think that the public needs to know that it's more than a document on reproductive ethics," McTernan said. "I think in its totality, it's such an affirmation of what we need in health care as part of the Catholic health ministry."
Unfinished business
Theologian Lawrence Welch opined that the new version of the Ethical and Religious Directives is an improvement over its predecessor, but still has holes. In the absence of a clear description of the principles of cooperation, he notes, the directives leave many possibilities open.
And rightfully so, according to Father Place, who argues that the bishops correctly deleted the Appendix defining cooperation because it caused a great deal of disagreement, and a new version probably would not have settled the disputes. “It was less than likely that another attempt would do it,” he said.
But since the new document does not limit appeals to mediate material cooperation, Welch worries that some ethicists may wrongly apply that principle to allow Catholic hospitals and health care organizations to continue somewhat close relationships with sterilizations. “I think that’s a misinterpretation, but the problem is if you don’t specifically exclude those misinterpretations, people are going to make them,” Welch said.
Yet making interpretations of moral principles is rightly a job for individual bishops, Father Place responded. He made an analogy to just-war theory, pointing out that Catholic ethicists generally agree on the broad principles involving morally legitimate warfare, but disagree on how the principles should be interpreted. He noted that the Holy See has not made a sweeping pronouncement on the details of hospital partnerships and how theologians should apply the principles of cooperation to health-care industry. Instead, Vatican officials have criticized or demanded changes in certain individual arrangements. “I think the feeling was, this is the way the tradition has worked on complicated things,” Father Place said.
For a hospital merger or alliance, the diocesan bishop is the authority within his jurisdiction, because he is the one who decides whether an institution can call itself Catholic. So Father Place maintains that diocesan bishops should be making the decisions on individual hospital agreements.
Father Place said that an accepted principle among theologians is that they need a “mature question” before they can give a good answer. That is, they need a situation where principles are clear and their various possible applications are understood and predictable. “At this point, I don’t think we have a mature question on the table,” Place said.
—Matt McDonald
Vatican’s Australia policy on track
Melbourne successor named for Archbishop Pell
The Vatican’s reform policy for the Catholic Church in Australia remains on track following the appointment of Archbishop Denis Hart as the successor to Archbishop George Pell in Melbourne, Australia’s largest archdiocese. It now means that Australia’s two largest cities, accounting for over one-third of the nation’s Catholics, have active orthodox leadership.
Archbishops Pell and Hart each received the pallium from Pope John Paul II, along with 34 other archbishops from around the world, in St Peter's Square on the evening of June 28. Archbishop Hart was chosen, on behalf of all the archbishops, to recite the oath of loyalty to the Holy Father.
Following Archbishop Pell’s transfer from Melbourne to Sydney (see CWR June 2001), it was widely anticipated that his successor in Melbourne would be auxiliary Bishop Denis Hart. This was confirmed with an announcement in Rome on June 22.
While an episcopal appointment to the Melbourne archdiocese might not seem especially newsworthy to Catholics elsewhere in the world, in this instance it has wider ramifications. Following the 1998 Synod of Oceania, the Statement of Conclusions and its implementation, and a recent succession of notably orthodox appointments to vacant dioceses, it indicated the Holy See remains attentive to the direction of the Church in Australia as a whole.
Two others of the eight or so vacancies remaining to be filled following Archbishop Pell’s move to Sydney have also been accounted for in recent weeks, with Sydney auxiliary Bishop Peter Ingham appointed to the Diocese of Wollongong, left vacant by Bishop Philip Wilson’s transfer to Adelaide, and Father Gerard Holohan to the Diocese of Bunbury. Sydney observers consider Bishop Ingham, highly regarded for his pastoral skills, as the best of the three auxiliary bishops. He is expected to provide continuity with the previous administration of Bishop Wilson. Bishop Holohan was formerly head of the Perth Catholic Education Office under Archbishop Barry Hickey of Perth.
However, the designation of Archbishop Pell’s successor in Melbourne was clearly the most crucial appointment. The reforms achieved under Archbishop Pell’s relatively brief (less than five years) leadership must still be consolidated. And two major cities, Sydney and Melbourne, can exert considerable influence in the rest of the country’s dioceses.
Staying the course
As a Melbourne auxiliary, Bishop Hart had been Archbishop Pell’s right-hand-man and was closely familiar with the workings of the archdiocese and its key personnel. In a media statement on June 23, Archbishop Hart confirmed the expectations of orthodox Catholics:
I will work hard to promote unity of faith in the Catholic tradition with Jesus Christ as its center. I will work energetically to gather the Church in Melbourne around Pope John Paul II in the Universal Church . . . . Archbishop Pell has provided Melbourne with a strong focus on Jesus Christ, with clear teaching, gifted administration and availability to all. For all Melburnians I thank him for his vision and leadership.
Ray Cassin, a religion writer in the liberal Melbourne Age—which had made a practice of regularly criticizing Archbishop Pell’s “hard-line” policies—offered some backhanded compliments to the new archbishop, under the heading “Protege of Pell Catholic leader." He observed that "the appointment of Bishop Hart will almost certainly mean that the most controversial policy changes implemented by Dr. Pell will remain in place." And he added:
But the appointment is also expected to have ramifications for the Catholic Church elsewhere in Australia. Bishop Hart’s appointment means an increase in the number of conservatives in the Catholic Bishops’ Conference. Of the seven Australian metropolitan sees (those based in capital cities), only two, Brisbane and Canberra-Goulburn, are now led by moderates or liberals.
During his first press conference, Archbishop Hart made it clear he would uphold Church teachings on contested issues such as the ordination of women and the morality of homosexual acts. “The Pope has stated definitively, after serious examination, that the Church is not able, is not competent, to ordain women to the priesthood," he observed. "That’s a definitive teaching for now and always. I don’t see that changing.” Regarding homosexuality, he said: “People who are active homosexually . . . exclude themselves from Holy Communion and therefore we are not free to give them Communion.”
A report in the Melbourne Herald Sun cited the assessment of one of Archbishop Hart’s clerical colleagues: “I think he and the Vatican understand that the Melbourne Church under George Pell gained a reputation for being assertive and both believe that momentum should continue."
—Michael Gilchrist
Back to Catholic World Report August/September 2001 Table of Contents