IEET > Rights > HealthLongevity > Economic > Vision > Contributors > Valerie Tarico > FreeThought
Do Religious Restrictions Force Doctors to Commit Malpractice?
Valerie Tarico   Jun 7, 2013   Away Point  

Picture this: You wake up far too early one morning because your hand is intensely painful and you don’t know why. When the pain gets worse, you go to the ER. The attending doctor, a gray haired man, examines you, draws blood, and then tells you an unusual flesh eating infection in your finger is putting your health at risk. He recommends amputating the hand immediately before the infection causes more harm. What he doesn’t tell you is that at this early stage the simple injection of a state-of-the art antibiotic would solve the problem. Why the omission?

woman with amputated hand His hospital is managed by a self-described religious healthcare ministry that forbids the use of antibiotics.

Across the U.S., religious healthcare corporations are absorbing  once secular and independent hospitals and in the process imposing  religious restrictions that sometimes pit standard medical practice against theology. To the best of my knowledge, no religious system that is licensed to serve the general public forbids the use of antibiotics. But facilities under the direct or indirect control of Catholic bishops are providing maternity care that is tantamount to unwarranted amputation.

Catholic Directives Delay Care, Compel Unnecessary Surgery

Ectopic pregnancy types Recently a woman was traveling across the Midwest when she developed abdominal pain. She and her husband went to the nearest hospital, where she was diagnosed with a potentially fatal ectopic pregnancy. The doctors recommended immediate surgery to remove the fallopian tube containing the misplaced embryo, a procedure that would reduce by half her future chances of conceiving a child. They failed to mention that a simple injection of Methotrexate would solve the problem, leaving her fertility intact. Why the omission? The Catholic hospital where she got diagnosed was subject to the “Ethical and Religious Directives” of the Catholic bishops, which state, “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”

According to Catholic moralists, an injection that destroys an ectopic embryo is a direct abortion, while removing the part of a woman’s reproductive system containing the embryo is not. While this may sound strange (or abhorrent) to outsiders, it has its own internal logic. Catholic ethics ultimately are determined by theologically based perceptions of what actions God approves and doesn’t approve. While compassion does matter, the end goal is to improve the spiritual standing or righteousness of the person performing the action. These theological dictates may or may not align with the questions that govern secular medical ethics and practice: how to minimize harm and suffering or maximize wellbeing while respecting patient autonomy.

In 2010, a pregnant Nicaraguan woman with metastatic cancer was denied treatment because chemotherapy could harm her fetus, which doctors refused to remove. Though many Protestants disagree, Catholic theology treats any product of conception as a fully formed human being, with rights equal to a woman from the moment of conception whether or not there is any possibility of it actually becoming a person. This means that abortion is an inherently bad action, regardless of outcomes. Nicaraguan law, rooted in this theology, prohibits all abortion even when a woman’s life is at stake. In 2012, a 16-year-old Dominican girl also was denied treatment for weeks while doctors debated whether chemotherapy would constitute an abortion. She eventually miscarried and later died.

Christianity traditionally has regarded women as vessels—vessels for evil and for babies. For Adam was formed first, then Eve. And Adam was not the one deceived; it was the woman who was deceived and became a sinner. But women will be saved through childbearing—if they continue in faith, love and holiness with propriety (1 Timothy 2: 13-15). As a consequence, Catholic rules addressing reproduction are particularly convoluted, and sometimes patients pay the price:

A Catholic doctor at a Catholic hospital went against my daughter’s wishes and signed consent to have a hysterectomy because of severe endometriosis. One ovary had already exploded. My daughter had never intended or desired children nor was she in a suitable situation to have a child. She was single, in her late 20s. When she awoke from surgery she learned that the doctor had over-ridden her wishes and consent in an attempt to save her fertility. The operation was botched, leaving my daughter on permanent disability, in pain, with even more health problems than she’d had before. – Comment at Truthout

Religious Directives and Malpractice Law

Secular medical ethics evolved to promote patient welfare and autonomy. As better treatment options become available, providers are expected to keep their skills and knowledge up to date so that they can provide accurate information about the range of options and offer the services most likely to create the best health outcomes for patients. Violation of these norms is considered malpractice.

Medical malpractice can be defined as: “Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other healthcare professional.” Whether or not a healthcare provider has provided excellent or unacceptable care depends on the general state of healthcare at the time service is provided.

The critical element is standard of care, which is concerned with the type of medical care that a physician is expected to provide. Until the 1960s the standard of care was traditionally regarded as the customary or usual practice of members of the profession. This standard was referred to as the “locality rule,” because it recognized the custom within a particular geographic area. This rule was criticized for its potential to protect a low standard of care as long as the local medical community embraced it. The locality rule also was seen as a disincentive for the medical community to adopt better practices.

Most states have modified the locality rule to include both an evaluation of the customary practices of local physicians and an examination of national medical standards. Physicians are called to testify as expert witnesses by both sides in medical malpractice trials because the jury is not familiar with the intricacies of medicine. Standards established by medical specialty organizations, such as the American College of Obstetricians and Gynecologists, are often used by these expert witnesses to address the alleged negligent actions of a physician who practices in that specialty. Nonconformance to these standards is evidence of negligence, whereas conformance supports a finding of due care. –Legal Dictionary

The recent case of a young Salvadorian mother named Beatriz offered a graphic example of how religious interference in medical care can force doctor to commit malpractice. Beatriz, who suffers from lupus, was pregnant with a nonviable anencephalic fetus yet was refused an abortion clear through the second trimester, as her condition became increasingly risky. Salvadorian minister of health, Maria Isabel Rodriguez, called her situation a “grave maternal illness with a high probability of deterioration or maternal death.”

Protest Poster -- Savita Deserved Better.  All Women Do.“I just want to live,” Beatriz told the press—echoing the sentiments of Savita Halappanavar who died last year after being denied an abortion in Catholic Ireland. Salvadorian doctors were willing to perform the needed abortion, but their hands were tied by laws based in Catholic theology. Finally, at 26 weeks gestation and under international pressure, a Salvadorian court ruled that Beatriz could end the pregnancy—via caesarean section. As in the case of the ectopic pregnancy, Beatriz was offered an invasive surgical procedure rather than the standard treatment which would minimize recovery time and leave her body intact. As best can be determined from news reports, the only reason the doctors had to cut her was to satisfy the Catholic pretense that this was an attempt to deliver a viable baby.

In the wake of Halappanavar’s death and Beatriz’s dangerously substandard care, Marge Berer, founder of the international journal, Reproductive Health Matters, questioned the ability of Catholic-controlled facilities to provide emergency obstetric services and asked whether they should be formally stripped of their right to provide maternity care more broadly. Unfortunately, with Catholic theology encoded as law in many countries and with Catholic healthcare ministries buying up independent care facilities here in the U.S., a woman may have few other options. If all currently proposed mergers are completed in Washington State, for example, nine counties will have all hospital beds tied to religious institutions by the end of 2013, including the University of Washington system.

Senior Citizen with sign - Give Me Liberty at my DeathWhen bishop directives trump science and patient preference, pregnant women are not the only ones at risk. According to a litany of articles at two watchdog sites, CatholicWatch.org and Mergerwatch.org, the problem of religious interference in health decisions extends far beyond obstetrics and family planning, spanning end of life care, treatment of queer families, and any drugs remotely derived from embryonic stem cell research. As medical science offers us more and more ability to manage sexuality, reproduction, body modification, and our dying process, religious dictates will be increasingly at odds with secular standards of care. Doctors working under these mandates will be forced to offer treatments that, by contrast with the best available, can be classed only as malpractice—a pattern that both patients and personal injury attorneys are bound eventually to notice.

Related:
How the Catholic Bishops Outsmarted Washington Voters
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.




COMMENTS

“the end goal is to improve the spiritual standing or righteousness of the person performing the action.”

An undemonstrated, unreferenced, assertion; a gratuitous swipe against the intelligence of readers and of scholars of any stripe, and at an _ethics_ site, no less!  As Wikipedia would say:  “Citation needed.”  Egregious [lack of] editing by IEET.

Understandably, Valerie needs to leave that claim undefended, since if she could demonstrate it, she might find that it’s a covert formula for the consequentialism she espouses.  We’re not told how medical consensus maximizes wellbeing or minimizes harm, two equivocal terms, and so we can’t assume this is anything more than an opinion-ethics piece; an author’s groping for righteousness and spiritual standing.

The author may already know my views from my past comments, so I don’t need to criticize her again:  this one is for the IEET editors.  You would not publish unsubstantiated claims about the goals of sociology, French banking, or astrophysics; that religion gets to be the de facto hacky sack around here undermines the otherwise interesting pursuits of your site.

@Henry: Since she spends the article demonstrating the truth of your quotation, particularly by contrasting that dynamic with the modern secular notion of medical ethics, I can only infer that you are being willfully obtuse - and that’s a charitable assessment. Which is, funnily enough, how some of the more cynically anti-theistic among us might judge to be the character of her assessment of the morally hideous excuses of medical practitioners she describes - a less charitable assessment may conclude that spiritual standing is lower on the list of concerns, subordinate to the drive to keep in place a barbaric social order that rips out of the hands of women, at any cost, the right to self-determination. Curious how Yahweh’s desires so closely align with those of retrograde bigots, no? Or is that too cynical?

This is what laws are for. The law must have priority over the religious preferences of the hospital’s management. If there is malpractice, the responsible persons and must be brought to justice.

It’s only malpractice because babies somehow became equated with microbial germs (the flesh-eating kind, in Valerie’s example), which is scientifically false in every embryology textbook ever written.

It is the burden of those making such literary and poetic false statements to reconcile with science.

Abortion and contraception place no shred of control in the hands of women; on the contrary, they deem women uncontrollable and destroy a fundamental part of them, their fertility.  They are heinous, misogynist acts.

@Henry: Where are babies equated with flesh-eating microbial germs? How does contraception destroy fertility? What ethical framework suggests that removing one’s sovereignty over one’s body actually increases one’s autonomy?

SHaGGGz, you’re too smart for me to have to spell this:  Dr. Tarico analogized amputation to the correction of ectopic pregnancy, and ingestion of antibiotics to abortion.  I retract my verb “destroy” and replace it with “subjugate.”  Contraception tells a woman that everything about her, except her fertility, is wonderful.  It’s not like saying everything except her cancer is wonderful; it’s like saying everything about her except her digestion or intellect is wonderful, which is in either case a cruel, odd, and misogynist statement.

But I don’t understand your last question.  What makes increased autonomy absolutely good?  Unbridled autonomy lands even the brightest and strongest of us in a 12-step program.  And how does refusal to spread one’s legs for an IUD, or refusal to ingest WHO Group-I carcinogens relinquish sovereignty over one’s body?

How is giving her the reins to her own fertility so that she may judge when to channel it towards reproduction and when to forgo it, based on her choice, telling her that it isn’t wonderful, ie telling her that the locus of this control, pertaining to within her uterus, is actually well outside her, in the hands of “God” ie retrograde gender essentialism? Why don’t we bring back male chastity belts, lest we give them the impression that their precious fertility is anything but wonderful, not to be misspent on Onanistic folly? Every sperm is sacred!

I never said unbridled autonomy, which is essentially a synonym for Hobbesian anarchy, was good. The modern consensus is not that a woman can kill her children, or even a sufficiently developed yet not born fetus, but that she has autonomy over her own body, the issue being the precise moment we choose to arbitrate the boundary between “person” and “bundle of tissues”. To insist that there is always a clear and unambiguous delineation in reality is just plain delusion - the only reason we use something as blunt as time since conception to decide abortability is a matter of legal practicality.

It’s not the refusing the IUD or contraceptive that relinquishes one’s sovereignty, but having one’s choices limited over one’s own body by others, who have zero business in the matter (with the possible exception of the partner), that does.

Perhaps if Henry Bowers didn’t exist, there would be more babies thrown in the garbage—1.3 babies per 2, 900,000,000 dumpsters, just for a number, rather than 1.0 babies per 2,900,000,000 dumpsters, say.
But no danger of Kervorkians becoming too numerous; most people want to live and staying alive means—in America—Medicare, Medicaid, subsidised prescription drugs. If Medicare and Medicaid were to drop in cost, Henry, such would be one sign Kervorkians are on the loose.

It is as impossible to channel fertility as it is to channel digestion.  One may, however, listen to the body and avoid food, or avoid baby-making.  Said avoidances are different acts than purging (to channel digestion) or contracepting.  The locus of controlling conception is never in the uterus (or the test tube), whether one acts for or against it; conception is a non-deterministic step in a process that starts with a special hug. 

And so we cannot conflate the 2 separate and distinct reasons why contraception is wrong.  Onanism is wrong not because it knowingly fails to be fruitful from the get-go, but because there is no intelligible good served by it, and so the man who readies his body for marriage when obviously no marriage exists acts dualistically, pretending that he is fulfilled by arbitrary pleasure instead of perfective activities known by universal reason.

Contraception is wrong because it pretends that components of a spouse’s personality (e.g. the fact that they are fertile) can be ‘shut off’ en route to something that is fulfilling and perfective of them; this ‘shutting off’ is again a dualistic action, when in the context of the marital embrace it opposes an essential component of the universally understood good of marriage itself, viz. openness to life.  And I don’t mean emotional openness; in considering what would intrinsically fulfill the kind of relationship marriage is, it is universally intelligible that the arrival of new life would constitute one such possible fulfillment.  Possible fulfillments might reasonably be avoided, but they cannot reasonably be opposed, lest the entire project of becoming married prove itself a grand charade — the charade of dualistic action.  But lastly, even among the unmarried, contraception is wrong because it purports to calculate in advance that another’s life qua life should be opposed for some measurable good, which is not only impossible, but brazenly supercilious.

Your final comment drives it home best:  we have zero business in pretending to decide that a possible person should be opposed.  Avoidance is one thing; opposition is another.  Contraception is a deliberate act of opposition.

How do Catholic hospitals justify all the hysterectomies and ovary removals (castrations)? These surgeries are PERMANENT BIRTH CONTROL and therefore in direct conflict with Church doctrine. They also violate the Church’s three ethical principles - respect for persons, beneficence, and nonmaleficence.

Many of the unnecessary hysterectomies could be avoided by the OFF-LABEL use of contraceptives as these medications are very effective in regulating the menstrual cycle and treating heavy bleeding (regardless of the underlying cause). These medications should also be used in lieu of ablation, another procedure that’s commonly done in Catholic hospitals but appears to violate Church doctrine. Ablation also has its own set of adverse effects (post ablation syndrome) far too often leading to hysterectomy - http://journals.lww.com/greenjournal/Fulltext/2008/12000/Previous_Tubal_Ligation_Is_a_Risk_Factor_for.6.aspx.

Are economics (profits) behind the overuse of these destructive surgeries that take much more from a woman than her ability to bear children? And how many are done so residents comply with Graduate Medical Education requirements - https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/220_Ob_Gyn Minimum_Numbers_Announcment.pdf?

Or could it be that the Church deems it necessary to de-sex women whose “childbearing days” are numbered or over since, in the Church’s eyes, sex is supposed to be purely for procreation and not for pleasure?

Whatever the reasons, hysterectomy is usually unwarranted. According to ACOG, 76% don’t meet their criteria for the surgery – http://www.ncbi.nlm.nih.gov/pubmed/10674580. Not only are most unwarranted, hysterectomy (with or without ovary removal) is a destructive surgery and increases risk for many health problems and reduced quality of life. A simple search of studies in PubMed makes this all too clear. The sequelae affect not only the woman but her family and all of society.

Hysterectomy and/or ovary removal should NEVER be a standard of care except in cases of gynecological cancer and possibly some cases of postpartum hemorrhage. It’s time that women’s sex organs be given the same respect as men’s and that women be provided INFORMED CONSENT as it relates to removal of the uterus and/or ovaries.

Just as a man’s sex organs have lifelong (non-reproductive) functions, so do a woman’s. This video explains the LIFELONG FUNCTIONS of the female organs - http://www.youtube.com/watch?v=C_nY1az2k00.

Henry Bowers kicked off this comment thread by attacking the author’s overall point that putting religious beliefs over and above the goal of providing an accepted standard of care is not acceptable thing for a hospital to do—-especially when we’re talking about some of the biggest hospital chains in the country. 

Curiously, after trying to deny this is what is occurring, he then goes on a rampage of unprovoked dogma-listing that utterly makes the author’s point for her.  Um, masturbation is still a sin in your book, Henry?  Really?  Because even the Vatican got tired of being laughed at for that one, pal.

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