The limits of Catholic healthcare in Wisconsin
by Taryn McGinn Valley
MD/PhD Candidate, University of Wisconsin School of Medicine and Public Health
Wisconsin prides itself on —in addition to our cheese — our communities. Historically, Wisconsin values have made us good neighbors, from small towns to big cities. When I applied to medical school here, I looked forward to learning from and experiencing these community values. In addition, my decision to pursue a career in medicine stems from my Catholic faith. Catholic hospitals used to represent, for me and in their own advertising, an open door to anyone in need of healthcare. However, as I’ve trained and worked in Wisconsin communities and learned more about Catholic healthcare, I’ve learned that Wisconsinites and Catholic hospitals are ignoring patients’ needs and even causing irreversible harm.
In medical school, we learn evidence-based medicine and do our best to practice this science and art in the busy daily world of clinics and hospitals. However, doctors who work at Catholic hospitals are bound by a set of religious directives that limit the care they provide – in direct contradiction to their training. This is where we as Wisconsinites and Catholic healthcare providers are letting our communities down. Catholic-affiliated hospitals are governed by the “Ethical and Religious Directives for Catholic Health Care Services,” or ERDs, a set of strict guidelines that tie doctors’ hands, preventing them from providing certain care even if they think it’s the best option for their patient. Clinicians at these Catholic institutions are prohibited from providing a wide array of reproductive services — contraceptives, sterilization, abortion, fertility services, and even some treatments for ectopic pregnancy (which can be an obstetrical emergency).
Catholic hospitals interpret these prohibitions in different ways, but ERDs can often outweigh patients’ desires, the urgency of a patient’s medical condition, and a provider’s medical judgment. In the end, this means that medically necessary care is sometimes unavailable at Catholic hospitals. This is true regardless of whether the patient is informed of the ERDs or not.
For some people, this is a mere nuisance that requires making a different doctor’s appointment. For others, it’s far more serious. They cannot take more time from work, they cannot travel to another hospital, or perhaps the Catholic hospital is the only institution in network in their community. Thus, religious limitations on care can mean delaying treatment, necessitating fragmented care, and creating increased risk of complications or even death.
These religiously imposed standards of care could mean tragedy or trauma for any patient. However, as is the case in many aspects of health and wellbeing, it is communities of color who are disproportionately affected. In Wisconsin, pregnant women of color, particularly black and Latina women, give birth at Catholic hospitals at a higher rate than their white counterparts. Given broader disparities that exist in our society, they are also more likely to face hardships—such as the need to work multiple jobs with inflexible hours or lack affordable childcare—that make it more difficult for them to simply choose another hospital system or insurance plan.
These trends were recently confirmed by a report from the Columbia Law School Public Rights/Private Conscience Project (PRPCP) in partnership with Public Health Solutions, “Bearing Faith: The Limits of Catholic Health Care for Women of Color.” The study compared racial disparities in birth rates at hospitals that place religious restrictions on health care, demonstrating a disproportionate impact of ERDs on pregnant women of color.
Of all the states studied, Wisconsin displayed the highest percentage of births at Catholic hospitals for all racial groups — and women of color are even more likely to give birth at a Catholic hospital. In fact, Wisconsin was the only state where black women were more likely than not to deliver their baby at a Catholic institution.
Medical providers who have worked in two Catholic hospitals in Milwaukee—Wheaton Franciscan-St. Joseph, which is located in a majority black neighborhood, and Columbia St. Mary’s—recently revealed in a news article the numerous ways in which the ERDs impacted the care they could provide to patients. In one instance, Dr. Jessika Ralph described being forced to wait more than twenty-four hours for her patient to deliver an eighteen-week fetus with no chance of survival rather than perform an abortion or induction, putting her patient at risk of infection, bleeding, or other serious complications. Dr. Ralph noted that she was bound by St. Joseph’s rule requiring her to wait until a patient “hemorrhaged or showed at least two signs of infection” before providing treatment. Doing nothing could have led to the patient’s death. And keep in mind, benevolence — doing good when we are able — is a core principle of medical ethics.
I’m being trained as a physician to put my patients first, and this kind of care puts them last — directly behind someone else’s values. I am proud to be a Wisconsinite, but something has to change. I have been a practicing Catholic my whole life, and these are not my values.
I remember my naïve thoughts about the altruism inherent in Catholic hospitals and wonder whether I would even consider a job in one now. It frightens me that once I start practicing, I will have to choose between being employed in the area where I want to work and providing high quality care to my patients. Under current rules, I would be forced to withhold care from my patients: I would practice unethically, not benevolently. For example, at Catholic hospitals, most women cannot get their “tubes tied” because of the ERDs. Typically, this surgery is done at the same time as a C-section: one surgery rather than two. But new mothers at Catholic institutions often must have (and be able to pay for) an additional surgery at another hospital. In my future career, the ERDs could also compel me to send a pregnant mother home with a fever and heavy vaginal bleeding, actively miscarrying, knowing that she could continue to bleed and even die at home. I could not provide simple medicine that would speed this process along — stop her bleeding and her pain — even though her miscarriage was inevitable. If the Catholics making these rules had the honor and burden of sharing these moments with patients, I wonder if they would continue to construct and enforce policies that endanger the lives of the women in communities they purport to serve.
Luckily, an inspired group of activists is working to change the paradigm of women’s healthcare here in Wisconsin. Organizations including Maroon Calabash, an Afro-Indigenous Birthwork Collective, the Wisconsin ACLU, and Columbia’s Public Rights / Private Conscience Project are bringing stakeholders together towards action on this issue. Our goal is to mobilize change and community activism regarding Catholic healthcare’s disproportionate negative impact on women of color in Wisconsin. I channel my Catholic grandparents as I model their faith and commitment, and because of their example, I am honored to join hands with those whose health and communities have been negatively impacted by Catholic healthcare restrictions. I encourage all Wisconsin residents to join us in the fight for equity for women of color harmed by religious imperatives that override thoughtful, informed medical care.