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Prior Commitments

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It’s always difficult to know where to start in discussions of these things, and I find I’m about to do an extra, intermediate post in a series I thought was going to be fairly straightforward.

Let me start out by saying that I think Lee gave a good example of precisely what I think is the wrong approach to this problem.

Lee’s post makes a number of unstated assumptions–for instance, that the primary purpose of a Catholic hospital, homeless shelter or adoption agency is to provide “services,” and that the nature and content of such services are properly defined by the state.

There is therefore one Real, Official, Serious Thing going on here–what the state has determined is important–and a lot of private, not particularly serious things, like moral and religious belief, which should not be allowed to intrude on the first things.

But precisely what I want is for Catholic and other religious institutions to refuse to accept the definitions erected by the state.  And I’ll admit to wanting that for rather selfish reasons, in some way–but I’ll get to the reasons in a bit.

Look at it this way–if the Catholic church honestly believes that all abortion is the murder of a child, then, faced with the requirement to hand out abortofacient pills in its emergency rooms, it should have shut those down forewith and without compromise.

If you don’t believe me, take a look at an analogous example–if such a hospital had been operating in Germany in the Forties and was told it could only continue to function if it agreed to euthanize patients who were deemed mentally defective or otherwise unfit–should it have looked around for somebody who WOULD provide that service, or should it have shut down without compromise?

And it’s no use saying that the German example is of something “really” wrong while the Connecticut example is not, because in both cases, the people sponsoring the hospital would think that the required “service” is really wrong.

But the Connecticut example is a good illustration of what I want to see some pushback on, so let’s go into that for a minute.

To answer John’s question–in the US, given the free exercise cluase of the First Amendment, the courts tend to provide wide lattitude for religious beliefs, including lots of exemptions to laws for religious reasons.  Therefore, although all states require children to be vaccinated for certain things in order to attend school, they give religious exemptions from such vaccinations to the children of religious groups that oppose them. 

And I think it’s too bad that the Connecticut dioceses did not drag the state into court on this one, because they almost certainly would have won.

Consider the situation as it existed, and existed.

Connecticut has exactly four Catholic hospitals.

Every single one of these is in a city with another, secular hospital that also has an emergency room.

The morning-after pill does not have to be prescribed in a hospital, and can in fact be obtained from any licensed physician, and can be taken up to seventy-two hours after intercourse and still be effective.

The state requires private hospitals in its jurisdiction to provide NO OTHER SERVICE in order to stay in operation.

In other words, your hospital may or may not have a cardiac unit, may or may not have kidney machines, may or may not do MRIs. 

There was one reason and one reason only to demand that Connecticut’s Catholic hospitals prescribe the morning after pill–to assert the will of the state in the service of one moral standard and to declare the Catholic Church’s moral standard to be marginal. 

I think the church did the rigt thing in Massachusetts–its primary responsibility is not to provide services but to serve God, and it should not collaborate in acts it judges to be immoral and unacceptable, whatever those acts may be.

In Connecticut, what happened was not exactly what it looks like on the surface.

In each of the four cities with Catholic hospitals, the emergency room remained open even in those hospitals, but it didn’t remain the same.

The outside providers need to make money and cover expenses, which means that emergency room visits that used to cost a couple of hundred dollars–being largely subsidized by church donations–now routinely cost over a thousand.  Or fifteen hundred.

Fifteen hundred is what the nearest Catholic hospital’s farmed-out emergency room service charged my older son for cleaning a wound and giving him a tetanus shot.

In other words, the poor of the state of Connecticut now have a much more difficult time getting health care of any kind than they did before the law went into effect.

And not a single person has been provided with a “service” that wasn’t readily available before.

It was, as I said, a power play, pure and simple.

But we are coming to a time when I’m going to want a hospital that will stand up to state requirements to provide “services,” and I’m only going to be able to get one if the churches operate their charitable institutions as religious institutions first–that they refuse to compromise even a little with requirements to provide “services” they find to be morally wrong.

But, more on that tomorrow.

And I will, indeed, get to the Muslim cabdrivers.

Written by janeh

December 27th, 2009 at 8:10 am

Posted in Uncategorized

6 Responses to 'Prior Commitments'

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  1. If there are other sources for the morning after pill, then we have no disagreement–it shouldn’t be required that the hospital (or anyone else) provide it. Even if it is a little hard on rape victims, who are probably very vulnerable and not thinking clearly at the time when they need it, they can still get it, so the hospital’s interests trump theirs. To me, a government mandate should be a last ditch effort to make sure that patients (in this case) receive good care.

    And no hospital should be required to perform more complicated treatment, whether it’s abortion or knee surgery or dialysis. That should be left up to the individual hospital, which can decide based on whatever criteria they choose–as long as, if they do choose to do it, they do a good job.

    I don’t really care why anybody chooses to start a hospital, or an adoption agency, or a homeless shelter. But I very strongly believe that once someone has taken on that responsibility, they can’t either give the patients/adoptees/homeless poor or harmful service, or just abandon them without making provisions for someone else to take over that service. Once someone is depending on you, you have an obligation to them.

    Once you have committed to providing service to someone, you are a service provider, even if that is not, to you, the main point.

    Do you have Urgent Care medical facilities in Connecticut? That’s where I would go here for a non-life-threatening emergency, like caring for a wound and a tetanus shot. (In fact, that’s where I did go for that a few years ago.) They’re a lot less expensive than emergency rooms–I think I paid $60 for my visit. They’re affiliated with the local hospitals, but usually in office buildings which aren’t on the hospital campus. They don’t have all the technology you’d need for, say, a heart attack or something. But they’re fine if you have the flu, or a minor injury. I don’t know if they’re just around here, or if they’re all over the country.

    Lee B

    27 Dec 09 at 5:04 pm

  2. I disagree entirely that once you offer a service, you are required to offer all kinds of other services, and you can’t disentangle yourself from the situation if it develops into one which requires you to violate your moral code. And in any case, providing a service is not the same thing as making someone dependant on you. There are other doctors, other hospitals…maybe not nearby or convenient or cheap, but they exist. And if they don’t, well, the local residents will have to try to hire doctors and set up hospitals. Rural communities do this all the time. Their failure rate might make people more willing to allow the Catholics their conscience as long as they run the hospitals.

    To put forward another example – a local group of people opposed the practice of euthanasia in a local animal shelter, so they set up their own group that organizes no-kill fostering and adoption (they haven’t yet raised enough money to set up their own shelter). If the city, alarmed by the large number of stray animals, passed a bylaw requiring all stray animals that were homeless after 10 days to be euthanized after 10 days, what would you expect these people to do? Agree to euthanize animals, since after all, people with unwanted animals have come to depend on their service? Or stick to their principles and shut down their operation, perhaps going underground to violate the law by sheltering homeless animals for more than 10 days?

    Cheryl

    27 Dec 09 at 5:38 pm

  3. They don’t need to offer all kinds of other services, but a hospital, say, should offer the services which a hospital usually provides, with at least standard quality. They can disentangle themselves, but it takes time & thought–they can’t just close their doors. Perhaps they can make arrangements for those locals to purchase the hospitals, and keep them running.

    In the case of the animal adoption, I would 1) Refuse to comply with the ordinance, loudly, publicly, and politely, 2) Mount a massive publicity campaign to let others in the community know about the ordinance, 3) Start looking for a lawyer who was willing to represent the group pro bono, 4) Arrange to have protesters at every city council meeting, and 5) Continue normal operations in fostering animals.

    In other words, civil disobedience in action. I see no reason a church or other group couldn’t do the same, if they ran up against some ukase which went against their sense of what is right.

    In this case, the government is trying to restrict services instead of mandating them. If the city didn’t cave & the court case went against the group (which I doubt), the group has the option of moving the fostered animals outside the city limits, & out of the city’s jurisdiction (at least around here that would work.) Since the foster group is not run or funded by the city, I doubt if the courts would let this stand. I’d like to say that no city council would be crazy enough to pass such an ordinance, which is bound to be unpopular, but some of them are crazy enough for anything.

    From my point of view, it is not the people with animals who are dependent on the group, it is the animals themselves. If, somehow, the city wins, the group should find homes for all animals being fostered at that time, not take in new fosters, and keep up the pressure on the city council.

    Lee B

    27 Dec 09 at 6:43 pm

  4. Closing down instead of providing services that are morally repugnant to the providers *is* a form of civil disobedience in action. Personally, I wouldn’t even have been conciliatory enough to rent out the ERs to other agencies so that they could carry out procedures that were anathema to me; that seems somewhat hypocritical to me. Selling the buildings and equipment to another group with other aims might be marginally acceptable. It’s better to refuse service than be forced into compromising such a core part of one’s belief – and we’re not talking about some minor traditional practice here.

    The problem still remains that the Catholic Church must, by their own beliefs, try to help the poor and sick, and they have been prevented from doing so by the state in which they are as much citizens as anyone else is. A state, moreover, that claims to honour freedom of religion. In the short term, the RCs can focus on related activities – a local group of nuns, having lost their role in public education, turned to other forms of helping others, including a day centre with meals and a food bank for the poor. Another group set up a private school with funding for students from poor families. But that sort of accomodation almost colludes in hiding what has actually taken place – the rule of law has been used to try to stop a group of people, identifiable by their religion, from participating in their society. It’s the Bible versions all over again.

    OK, explanation for those not familiar with my area. It is perfectly legal in Canada (well, can be, depending on province) to have publically funded religious schools, and the nuns in question found themselves out of education when our provincial government decided it could save money by eliminating denominational schools. And one of the things that prevented public non-denominational schools from being set up in the first place back in the 1800s was the Protestants passing laws that required the KJV of the Bible to be used as a school text – again, not saying outright ‘we don’t want Catholics to participate in our society’ but ensuring they couldn’t, in conscience.

    By the way, I’m not RC myself, although I am familiar with and very interested in the church. I think I’m coming across as a Catholic who can’t see both sides of the issue.

    Cheryl

    28 Dec 09 at 7:02 am

  5. I find myself agreeing with Jane in cases where alternate options for health care/services exist. In those cases, yes, the religious folks ought to be left to provide what they please, as any other hospital or doctor provides only those services that fit with their skills and philosophy.

    My big concern, though, is those places where no alternatives exist. Where a Catholic hospital being available means that no other hospital will enter that market. Where the only pharmacy in an isolated small town won’t dispense birth control to single women (or married ones, for that matter). What does someone in need of religiously controversial treatment do?

    There can be emergency situations not amenable to traveling to other care where a mother’s life is endangered by a pregnancy. What does a Catholic health provider do in that case? Watch the mother and baby die in preference to an abortion? I don’t know how this is resolved in Catholic hospitals.

    For the pharmacy situation, there are now alternatives that didn’t exist 20 years ago, such as online or mail-order pharmacies. There’s still the difficulty of finding a doctor to prescribe, and in some cases such as the morning after pill, getting the drugs in a timely fashion. But less so than there used to be. So that’s not as urgent a situation, I’d think.

    But I’ve got to wonder if a hospital (the only one in the area) run by Seventh-Day Adventists opened up, and didn’t provide blood transfusion, and someone (not religious) came in nearly dead from loss of blood, what would happen? What if that person died? If it were elective or non-emergency surgery, the person would at least have the opportunity to choose to go elsewhere, but in an emergency, if the only proper treatment is prohibited by the religion of the provider, I’d say screw the religion, save the life.

    It’s one thing not to provide specialty services like MRIs or heart transplants. It’s another not to provide basic common care that is a frequently encountered situation. Now…whether services like abortions are common or speciality is another issue.

    Lymaree

    28 Dec 09 at 2:14 pm

  6. I think I must have spent too much of my formative years in small towns – I just don’t get all that ‘what about access in small towns’ stuff. I mean, if – I mean, when – you want something that isn’t available locally, you deal with the situation. You figure out a way to get it, you do without it, whatever. No one expects the local clinic to provide a full range of services, and if it’s something like abortion – I’m willing to be that would get added on to the list of things to have done in the big city. More privacy, and a doctor who’s probably done more than one or two a year.

    I gather the SDAs have alternatives to transfusions. They give presentations on them about once a year to the surgeons here.

    I don’t see what’s so shocking about the possibility of dying because the proper treatment isn’t available. That happens. Anyone living in the more rural parts of my province knows that if they have a heart attack, it will take them much longer to get to a doctor than in the city, and the doctor they see will be far less qualified and experienced in treating heart attacks than the city ER doctors and specialists. Ditto for trauma. If the first responder doesn’t think a transfusion is appropriate, it won’t matter to me as patient whether the reason is because he is incompetant, because he has religious scruples, or because they don’t have any blood nearer than the regional hospital. These things happen. Patients don’t always have accidents near facilities that provide the type of care the patient would have wanted. Trying to micromanage things by keeping the religious people out of health care isn’t going to change that.

    Cheryl

    28 Dec 09 at 5:14 pm

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