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How the Catholic Bishops Outsmarted Washington Voters
Valerie Tarico   May 24, 2013   Away Point  

When it comes to matters of individual conscience, Washington State voters have a don’t-mess-with-us attitude that makes Texans look like cattle—and it goes way back. In 2012 Washington voters flexed their muscle by legalizing recreational marijuana use and marriage for same-sex couples.

In 2008, death with dignity passed some counties by as much as seventy-five percent. In 2006, Washington lawmakers outlawed discrimination based on sexual orientation and gender identity. In 1991 a citizen initiative established that “every individual has the fundamental right to choose or refuse birth control” and “every woman has the fundamental right to choose or refuse abortion.” It also guaranteed an absolute right to privacy around mental health and reproductive issues for teens aged 13 and up. Washington State’s constitution includes an Equal Rights Amendment and (from the get-go) a stronger wall of separation between church and state than the U.S. Constitution.

These measures have broad support from Washington citizens of all stripes including most religious people. That includes most Catholics, who, in the words of one Seattle parishioner, think that the bishops “need to get over it.”

In other words, west of Moscow, Idaho, and north of Portland, any bishops who want to control what they think of as their sacramental turf –birth, coming of age, sex, marriage, trippy transcendent experiences, and death—haven’t got a chance in hell at the ballot box. Washington even has extended statutes of limitations on child sex abuse—something Archbishop Timothy Dolan successfully fended off in New York and Pennsylvania. The Archdiocese of Spokane declared bankruptcy.

But the Vatican hasn’t survived for fifteen hundred years by being stupid. And as my devout family members like to say, “Where God closes a door, he opens a window.” The window the Bishops found open in Washington takes the form of independent hospitals with financial problems.

Thanks to changes in health care delivery, more and more independent hospitals are being forced to merge with large health care corporations. The pressures include expensive equipment, complex electronic record keeping technologies, and an Obamacare-driven push for greater administrative efficiency. Rather like mom-and-pop hardware stores that survived by becoming Ace franchisees with standardized, streamlined supply and distribution systems, independent health facilities are surviving through acquisitions and mergers with other hospitals and health care corporations.

Of the largest health care corporations in the country, five of six are administered by the Catholic Church including the famously conservative Catholic Health Initiatives which operates the Franciscan brand and has $15 billion in assets. By the end of 2013, if all proposed mergers go through, 45 percent of Washington hospital beds will be religiously affiliated. In ten counties, 100 percent of hospital facilities will be accountable to religious corporations, which are rapidly buying up outpatient clinics, laboratories, and physician practices as well.

In the words of the U.S. Conference of Bishops, Catholic hospitals and health care corporations are “health care ministries” and “opportunities:”

New partnerships can be viewed as opportunities for Catholic health-care institutions and services to witness to their religious and ethical commitments and so influence the healing profession,” . . . “For example, new partnerships can help to implement the Church’s social teaching.” 

Here is the diabolical stroke of genius. In any merger between a secular and Catholic care system, fiscal health comes with a poison pill. One condition of the merger is that the whole system becomes subject to a set of theological agreements call the “Ethical and Religious Directives for Catholic Health Care Services” or ERDs. Rather than care being dictated by medical science and patient preference, a set of religious doctrines place restrictions on what treatment options can be offered to (or even discussed with) patients.

Under these agreements, the patient-doctor relationship becomes a patient-doctor-church relationship: The Church’s moral teaching on healthcare nurtures a truly interpersonal professional-patient relationship. This professional-patient relationship is never separated, then, from the Catholic identity of the health care institution.” Furthermore providers who work in these systems are required to sign binding contractual agreements to adhere to the religious directives, whether or not they are Catholic: “Catholic health care services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives . . . .”

The ERDs in full are readily available to the public, but here are some key samples and implications:

  • Fertility Treatment: “Reproductive technologies that substitute for the marriage act are not consistent with human dignity.” This provision excludes in vitro fertilization and related treatments. It especially affects same sex couples, who may rely on surrogacy or insemination for childbearing, but it also affects the 10 percent of American couples who have fertility problems.
  • Contraception: “Catholic health institutions may not promote or condone contraceptive practices.” . . . “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.” While we don’t typically associate contraception with hospitals, state-of-the-art long acting methods like IUD’s increasingly are provided at the time of delivery, because post partum insertion improves health outcomes. Under ERD guidelines, a woman who delivers a baby at a Catholic hospital and wants and IUD or to have her tubes tied has to have a second, separate procedure at a secular facility—if they can find one.
  • Abnormal Pregnancies: “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.” Catholic practice encourages the removal of the entire fallopian tube to end an ectopic pregnancy, rather than the standard practice which simply ablates the developing fetus. That is because the standard treatment is considered abortion, while in the invasive and fertility-destroying surgery, death of the embryo is simply a side effect. More broadly, Catholic “ethics” forbid abortion even to save the life of a mother carrying a nonviable fetus. The battle to save a young woman named Beatriz in El Salvador exemplifies this very situation.
  • Advance Directives“a Catholic health care institution . . . will not honor an advance directive that is contrary to Catholic teaching.” Where patient directives and bishop directives conflict, the directives of the bishops take precedence regardless of a patient’s own religious or conscience obligations.
  • DNR“The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.” Since this battle heated up, stories are emerging in which Catholic hospitals have force fed incapacitated patients whose advance directives specifically stipulated that this not happen.
  • Death with Dignity“Catholic health care institutions may never condone or participate in [Death With Dignity] in any way.” Physicians are prohibited even from discussing options that exist in other institutions or making referrals.

To many non-Catholics, the most shocking statement in the ERDs is the suggested alternative to death with dignity: “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.” Redemptive suffering is a theological notion that derives from the crucifixion story—the idea that the blood sacrifice of a perfect being could redeem harm done. (Theories about how this works have varied over the course of Christian history.) By extension, suffering itself has redemptive value, which is why Mother Teresa’s order, for example, practiced self-flagellation and glorified suffering of the poor, ill and dying.

Given the clash between Washington State’s independence streak and the top-down approach of the Catholic bishops, Washington citizens are pushing back. After Catholic Peace Health got an exclusive contract near her home in the San Juan Islands, advocate Monica Harrington created a website, to complement the efforts of the national Merger Watch. Merger Watch has been fighting the religious takeover of secular systems across the country for over a decade, and sometimes winning, but describes a recent surge that overwhelms their resources. The ACLU of Washington is ramping up and aggregating funds to fight for a state-wide solution, the first in the country, and is soliciting stories (confidentiality protected) from patients and providers anywhere in the U.S. who have experienced religious interference in medical decisions.

Even so, on May 20, the Seattle Times announced an affiliation agreement between the University of Washington system and Peace Health. Within Catholic-controlled hospitals, less than five percent of revenues come from the Catholic Church. Most are taxpayer funds in the form of Medicaid, Medicare and capital grants for public services—or insurance reimbursement. So, the thought of the bishops influencing a public owned and funded institution adds insult to injury. In response, Columnist Danny Westneat, of the Times, framed a pointed question. “Most of us aren’t Catholic, so I’m guessing we’d never go along with letting the creeds of that one faith run something as universal as education [even if ‘the Catholics have a good record of running quality schools’]. So why are we allowing it with health care?”

Why indeed.


Eight Ugly Sins the Catholic Bishops Hope Lay People and Others Won’t Notice
The Difference Between a Dying Fetus and a Dying Woman
Catholic Hierarchy Lobbies to Suppress Religious Freedom
Self-Flagellation and the Kiss of Jesus–Mother Teresa’s Attraction to Pain
The Freedom to Die in Peace
Anti-Contraception Cardinal Paid Pedofiles to Disappear

Dr. Valerie Tarico is a psychologist with a passion for personal and social evolution.  In 2005, she co-founded the Progress Alliance of Washington, a collective of future-oriented donors investing in progressive change.


Before Henry gets in his Verbose Vatican Vitae:
hail Washington state, and Heil Texas.
We don’t have to be on the defensive all the time, Valerie; we are men and women—not mice. We do not have to justify every wind of doctrine in exhaustive detail to every Henry on every site.

Pete, it isn’t what Catholics (and Catholics are the more civilised of the religious) and others of their kind say, it is the lack of holism involved.. an entirely fair caveat: Jesus was not a theologian, nor Religious Studies professor at Jerusalem University. If one does not relate theology to life—as Jesus did—if one divorces theology from outside (carnal) considerations, one isn’t even a theologian; one is a philosopher possessing little/no spiritual content. If someone does not subscribe to everything the New Testament says, ‘Christian’ might possibly not be the right designation, perhaps Jesusonian Philosopher would be more accurate.
What I dislike about Henry is he has revealed nothing about himself, he is as a card player hiding his cards—IMO such is devious for a religious person. And again, and again, this is IEET, not an exclusively religious site by any means. Perhaps Turing Church would be a better site for Henry?
However the main problem is when you add up the hours we spend debating it becomes days; when we go on and on concerning religious issues at IEET it is:
then again…
that is to say…
on the other hand…
If we are going to converse in circles for decades, I for one would like to know now, not find out years from now we are fated to be argument machines. It isn’t merely I’m exercised at religious people in America. When one blogs at IEET, though, one does expect more.

“If someone does not subscribe to everything the New Testament says, ‘Christian’ might possibly not be the right designation, perhaps Jesusonian Philosopher would be more accurate.”

This seems like a standard that would render virtually no extant Christians, judging by the unsurprising and sensible progression of modern society beyond Bronze Age nonsense. Jesusonian Philosopher is a bit of a mouthful but I like it for a reason that you likely did not intend, namely how it dismantles the mass hallucination that suggests the need for a separate category of “theology,” which is really just a subset of philosophy with particularly ill-examined axioms.

I hate to break the awful news to you Summer but yes, you can expect a giant proportion of discussion to center around religion for the foreseeable future, especially on a website concerned with the intersection of ethics and technology, with regard to such an explosively divisive yet deeply emotionally embedded topic as religion.

@SHaGGGz re “you can expect a giant proportion of discussion to center around religion for the foreseeable future, especially on a website concerned with the intersection of ethics and technology, with regard to such an explosively divisive yet deeply emotionally embedded topic as religion.”

Probably true. Often it is not “discussion” though, but repetition of static positions already over-stated and over-discussed. I still have to see one person change mind as a result of a discussion here.

It doesn’t have to be “divisive” you know. Personally, I warmly welcome everyone to embrace or reject whatever religious idea stirs their emotions, provided of course they extend the same courtesy to me.

@Giulio: You are probably right in your assessment that nobody commenting here has had their mind changed. Such statistics are low to begin with when it comes to topics that are so closely linked with identity, especially in these times of culture war. Furthermore, I think there are significant selection effects at play with this site in particular, with its relatively fringe status, along with the comments system that requires its own registration, we are left with a small unrepresentative sample of the broader populace that feels strongly enough about its opinion to overcome all these hurdles.

“What I dislike about Henry is he has revealed nothing about himself, he is as a card player hiding his cards—IMO such is devious for a religious person…When one blogs at IEET, though, one does expect more.”

Actually it doesn’t bother me. I don’t need to know much - well anything, really - about Henry to weigh his arguments, and indeed be curious about them. At least I learnt that there is something called Basic Goods Theory. Not that it looks remotely likely to add anything useful to secular ethics, but it’s always interesting (to me) to know what kind of ideas are knocking around.

But you and I have different sensibilities, and a different experience with religion.

“Pete, it isn’t what Catholics (and Catholics are the more civilised of the religious) and others of their kind say, it is the lack of holism involved.”

No, for me it really is what they say. When Henry states baldly that any form of contraception is evil, justifies it on the basis of some trumped up normative theory that is then touted as Absolute Truth, and shows a total misunderstanding of the basic concept of moral subjectivism…well, I just have the urge to argue, as I do with Alex. (Henry at least sticks to the arguement and takes it to its logical conclusion rather than just changing the goalposts, though where he ends up as a result is…well, ‘chilling’ is the word that came to mind on the previous thread.)

That being said, what you call a lack of holism seems somehow related to what I identified as a lack of empathy. You’re right in saying that it ends up amounting to philosophy without spiritual (though I will rather say ‘emotional’ or ‘aesthetic’) content. It is that so common delusion that to be truly rational one must completely delegitimise emotion and aesthetics. Henry thinks, astonishingly when you think about it (which is perhaps why he dropped out of the conversation) that because I insist that an emotional/aesthetic response is necessarily involved in one’s moral choices that I am therefore allocating no role for my ‘mind’, by which I think he means reason and logic. Of course in reality the opposite is true: to be truly rational one needs not to delegitimise or ignore emotions (which itself is almost certainly a fear response) but rather understand and incorporate them.

In summary, I appreciate the logical clarity and coherence of thinkers like Henry, and I don’t insist on knowing more about Who He Is. And it is precisely because that logical coherence is incomplete, in particular with regard to its understanding of human emotion, that I have the urge to take issue.

We will not become argument machines, conversing in circles for decades. We’ll develop ‘bots for that. What we are doing is participating actively in the battleground of ideas, however incrementally, and (in my case at least) learning in the process.

” I still have to see one person change mind as a result of a discussion here.”

Giulio, it depends what you mean by ‘change mind’. Unless we really are Intomorrow’s ‘argument machines’, these discussions are certainly influencing us in various ways. As noted above, my recent exchange with Henry (in response to a previous article from Valerie) brought me into contact with Basic Goods Theory, which I previously didn’t know existed. And more generally these debates have definitely helped to shape and refine my ideas.

Actually I think SHaGGGz may be exaggerating somewhat the extent to which religion is bound up with identity, especially for people commenting here. I doubt that any of us are so utterly attached to our beliefs (regarding religion) that we cannot possibly imagine how we might live if we changed them. Are we? It’s just that unless someone actually exposes a logical flaw or empirical error in our beliefs, online discussions like this have little motivational power to make us change our minds. And when that does happen, we usually just go quiet for a while and then when (if) we come back our position has changed subtly, perhaps imperceptively to all but the most observant.

In other words, perhaps we are changing each others’ minds more than we might think just by looking at the apparently endlessly repeating arguments. There is an evolution, it’s just on a timescale that tends to be a lot longer than the duration of a single thread (and even when a crisis is reached and a commenter changes his or her mind, he or she will almost certainly not admit it, at least not directly).

“perhaps we are changing each others’ minds more than we might think”

It is pleasing, Pete, how you comprehend the difference between us Yanks and Europe. The following is addressed mostly to Henry, to discuss on his—that is, the Scripture’s—own terms.
Christians such as Henry do change my mind, for convoluted reasons: some based on gobbledygook from childhood; some on sound reasoning from Henry and other Christians.
Plus other faiths.
However being a trimmer, telling others what they want to hear, is too disingenuous, un-Christian. One can’t say “Jesus is King of Kings Lord of Lords” if one does not fully accept Christ being King of Kings Lord of Lords; if one has doubts concerning the central doctrine that Jesus is the King of Kings Lord of Lords, one probably ought not acquiesce. A relevant heuristic is, if one has doubts, don’t go along. From reading the Bible I personally think Jesus is King of Kings Lord of Lords, at least in the symbolic sense—yet Christianity isn’t merely symbolic. Jesus was well-grounded in both abstract faith and the ways of the world; Christ did not write theological papers to be filed away- He wasn’t a tenured Religious Studies professor, or Dean at divinity school. We with few exceptions all have to temporise at times; we wouldn’t enjoy telling the religious (esp. relations during the Holidays) their faiths are ancient notions to fill empty heads with comforting fluff, would we? Thus we don’t, we string them along in saying something along the lines of, “Jesus was a great teacher…”, and one might rightly claim such makes us dodgier than the religious however tactful we are in doing so.
Any which way I look at it, it appears wrong to acquiesce in something involving such a central tenet of a creed. If one has doubts of Mohammad being the Messenger of Allah, it would be quite difficult to rationalise being a genuine Islamic- because to submit to Allah one must believe completely Mohammad is the Messenger of Allah.
Henry might think I dislike Christianity, but it would be mistaken to think so. If one is raised Christian, one tends to retain Christianity, at least subconsciously (and don’t forget collective unconsciously). Nevertheless, being raised a Christian isn’t a good enough reason to call oneself a Christian unless one accepts the entire package of Jesusness. There’s no part-time Christianity: Jesus’ job description in the New Testament demonstrates He had no golden parachute: Christ was to be sacrificed. The Bible makes it plain the faithful are to be self-sacrificing; if one wants to be Christian one must make great sacrifices. Jesus did not say “be a transhumanist and do one’s thing, Babe.”
That wasn’t Christ’s Bag. I do entirely accept faith, in this case Christian faith/piety, albeit as nomos, nexus; and less positively, as default, necessary (or as you might write, useful) fiction. Beyond that IMO there’s nowhere else to run with the ball. I perceive no evidence of an afterlife.

First I would have to know if Henry is a genuine Christian, because if not, it would be the blind leading the blind. With Alex there was some rather small difficulty at the start; now, though, it is clear he is not misrepresenting himself/his faith. I know what (who) pastor Alex is, he isn’t particularly mystical yet he does accept the morality of Christ—and please remember the problem isn’t the morality of Jesus, it is the distorted message of today’s less… shall we say, ecumenical.

I agree that one shouldn’t, in general, go around pretending to believe things one doesn’t believe. But,to be pragmatic, I think it’s important to tolerate and even promote interpretations of words like ‘Christian’, ‘Moslem’, ‘Mormon’ and so on, without requiring people identifying themselves as such to believe, as a former Anglican bishop once put it, six impossible things before breakfast.

That said, I also agree that we need to be careful with tactful (but potentially misleading) consolatory statements like “Jesus was a great teacher”. Such is inauthentic not so much because we don’t think he was (probably he was, at least in some ways) as because fundamentally we don’t CARE whether he was or not. And that’s the whole point in a way: our issue, not so much with ‘the religious’ sui generis but with those (like Henry) who take religious doctrine too seriously, is that they are attaching importance and significance to past events or scriptural texts that really don’t deserve that much attention.

In summary: we don’t always need to make such an issue out of our unbelief, but if the subject comes up, I agree that we must be authentic: polite, but without distorting our message unduly in order to spare people’s feelings. Such just spreads obfuscation and confusion.

Aye, we don’t want to underestimate faith- yet neither do we want to overestimate faith.
If a secularist praises religion, the risk is damning faith with faint praise. Saying faith has placebo value is not something the truly religious want to hear often- even if such is thoroughly correct. Even praising family values (which to me is practically synonymous with faith: what is organised religion without famiy values?: disorganised religion!) isn’t exactly what Believers want—they want one to turn one’s life over to the deity. And it is true in that way they weed out unbelievers.
I don’t dislike the religious, Pete, I only hate the GOP; it is better to say one hates than to pretend love, IMO.

@Peter:  I would value any links you could provide to versions of moral subjectivism you find convincing.  I think the only distinction Basic Goods Theory (or NNL for New Natural Law, which is also Grisez’s project) emphasizes is the Aristotelian notion that we can’t define or conceptualize individuals; I don’t know what a rock qua rock is, or how to define it; I can only define rock as “a chip of mineral substance”.  Therefore, as the rock on the ground does not exemplify all that could ever be understood as rock-ness, so neither can the subjective goals of one’s purpose be found de facto compatible with rationally grasped benefits for humans; they may be compatible (and thus good) but they might not; therefore they cannot reliably guide moral action in the absence of concepts everyone understands, and especially the basic goods which generate all purposes.

@Intomorrow:  I consider true Christians to be beggars telling other beggars where the food is.  I believe I need supernatural help to reach a supernatural end.  What credentials constitute a true Christian for you?

I haven’t commented on this article because I see no problem with Dr. Tarico’s apparent objection to the Church’s proselytization and expansion of reach.  The great part about America is that no one has to visit a Catholic hospital, but that the care there is still certified and insurance will still cover it.  All 3 tenets are now changing:  (1) Obamacare will outlaw Catholic hospitals as terrorist cells impeding public health;  (2) Obamacare, which requires me to purchase insurance, will require me to submit to examinations, surgeries, drugs, and death-panels;  (3) Insurance will not cover services at Catholic institutions, and will be forced to cover that which has nothing to do with medicine, such as contraception.

“What credentials constitute a true Christian for you?”

Just for starters:

1. One who forgives one’s enemies- which is rare.

2. one who knows that it harder for a rich man to enter Heaven than it is for a camel to go through the eye of a needle.

3. one who lays up treasures in Heaven.

4. one who doesn’t want to bomb other nations in the name of God; one who doesn’t think ‘my country right or wrong.’
Because God doesn’t go by passports or customs houses.

5. one who doesn’t treat women like children, and children like property.

If the above and more can’t be realised, then no purpose in being a Christian.. there are other faiths, as you know.

“...(3) Insurance will not cover services at Catholic institutions, and will be forced to cover that which has nothing to do with medicine, such as contraception…”

Have nothing against the RC Church except the ideologues in the Church. The Church has many civilised members- and is a sophisticated institution (if such is to be considered spiritual). Unfortunately, being opposed to contraception is not spiritual, it is Rightist- ideological, and in some cases nothing more than wedge issue. Sometimes even based on hysterical reaction. Contraception IMO is a non-issue whereas abortion after the second trimester is a legitimate issue. Naturally, also partial-birth abortion and stuffing newborns in dumpsters and drainpipes. Assisted suicide is a non-issue as well, although some abuses have been brought to light—but few. Because the numbers of cases of abuses involved in assisted suicide is low, it is about as low an ethical priority as flag burning.
Do not neglect a mention of how the government protects the Church and its property via police and military—plus in other ways.
BTW, the Manicean-type Christian view of good v evil is reflected back at Christians: if they perceive others—without proof—as evil, others can see Christians as being the same; they can point to Catholic lapses and use them against Catholics.


Intomorrow, nobody should perceive others as evil.  They may be dangerous, or their actions evil; but neither does ontological goodness entail moral goodness.

Now we’re getting somewhere. At any rate, getting back ontopic is an ontological positive- before someone writes “knock it off, you obsessive compulsive commenters.”
It still appears despite anything you’ve written assisted suicide and Catholic opposition to it are minor issues. If assisted suicide is important, existential threats are enough to make a concerned citizen flagellate himself, tearing out his hair as well. Prioritisation is necessary in every way, ontologically, morally. the number of cases of abuse of assisted suicide is a low one, so much so that Kevorkian was a celebrity to make light of (“do you have Kevorkian on speedial?”). There’s a disproportionality in your reckoning. Terri Schiavo’s media circus was an indication of grandstanding on the part of the faithful—more disproportion.
If you run a hotel, being excessively concerned with doilies on the dressers in the rooms may cause you to neglect crucial business matters. If hypothetically jaywalking is a capital offense, what is the appropriate punishment for murder?: boiling the convict in oil? The disproportion is the concern IMO, not the morality of your faith. it appears a waste of time to be exercised about the rare cases of assisted suicide abuse; esp. the circus surrounding certain cases; grandstanding about

We two have much in common: raised a Christian, I tend to be backward-looking, remembering the way it was when men were men and sheep were sheep. Plus at IEET, we two are usually offtopic from the get-go, as we don’t focus enough on transhumanism and space interest. At a religious site, what we are discussing is just fine; here we are both obviously trapped in the past. And it is quite safe to write that IEET is not focused on the past and its faith based thinking. Something to keep in mind—for both of us.

@Henry: “I believe I need supernatural help to reach a supernatural end”

How do you go about acquiring said help, given you are confined to the same natural realm all humans are, and mitigating the manifold ways in which said apes are known to engage in delusional thought processes?

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