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Conscientious Refusal of Care: Vatican hobbles competing clinics

The Vatican forbids birth control and abortion services in Catholic hospitals and tries to prevent them being offered elsewhere. In 2018 the Trump administration created a special office to protect healthcare workers who refuse to treat people on religious grounds. The Church even tries to get the United Nations and national governments to cut off funding for birth control and abortion to competing clinics. This profitable worldwide strategy has seen Catholic bishops lobbying to ban abortion providers in the US from any government funding.

US Catholic hospitals are prevented by religious directives from providing some reproductive and end-of-life treatments. [1] The Stupak-Pitts Amendment, passed by the US Congress in 2010, ensures that no facility providing abortion can collect funds from the government health plan for any of its services. [2] There is a similar ban at the international level, called the Helms Amendment, which, in practice, bars US foreign aid funds from going to international organizations that perform or even talk about abortion. [3] At the same time the Vatican is tightening its control over the health care services that it runs and in 2011 fired the head of Caritas Internationalis, is an umbrella organization that unites numerous Catholic aid organizations worldwide. This was done to strengthen its “Catholic identity”, in other words, enforce Vatican doctrine. [4]

The medical directives of the Catholic Church enforce what it calls the “culture of life”. This allows gives it control over “human life from the first moment of conception until its natural end”. The idea is brilliant. The Church can use its power to try to get its members to outbreed the competition, yet because  the “culture of life” encompasses more than reproduction, this is not apparent. Attention is drawn away from the bans on birth control and abortion by two further bans: on ending your own life (voluntary euthanasia) and on carrying out the death penalty (capital punishment). Of course, forbidding voluntary euthanasia also serves to give the Church more control over people’s end-of-life decisions, but its main function seems to be to lend a consistency which masks its reproductive purpose. And the ban on capital punishment makes the “culture of life” philosophically complete.

The Bishops' Huge Financial Stake in Stupak-Pitts

Wendy Norris
RH Reality Check, 13 November 2009 

The justifiable anger at the U.S. Conference of Catholic Bishops for lobbying on the Stupak-Pitts amendment overshadows what is possibly the bigger motive for the Vatican: the billions of dollars at stake for the church's hospitals.

The scale of the church's involvement in the rapidly growing $2.5 trillion dollar American health care industry is staggering.

What the Stupak-Pitts amendment does for the Catholic health care system is omit a competitive advantage secular and other religiously-affiliated hospitals without doctrinal restrictions can use to simultaneously market their services to both the expected influx of newly insured patients and the outpatient medical professionals who will treat them. By restricting insurance coverage of women's reproductive health care, the competitive barriers faced by Catholic institutions will be be eliminated [...].

And in the case of an industry that accounts for 18 percent of the gross domestic product and is expected to double in less than 10 years, it's absolutely critical to follow the money.

One in six patients are cared for in 624 Catholic hospitals scattered throughout the U.S. in 2006, according to the Catholic Health Association. The church also operates more than 800 post-acute care, senior living and skilled nursing centers across the nation. All told, $84.6 billion was spent on Catholic church-affiliated care.

The Denver-based Catholic Health Initiatives is now the largest of the church's hospital systems in the country with 78 hospitals and 40 long-term care facilities in 20 states and operating revenues exceeding $9.6 billion ranking it sixth among all for-profit and charity health care networks.

Now consider that there are 60 some Catholic-affiliated hospital systems in all 50 states — representing 13 percent of the nation's entire in-patient health care system. That's easily tens of billions of dollars flowing through the business arm of the Catholic church that continues to grow through mergers with private and other religiously-affiliated hospitals.

Congressional health insurance reforms promise the prospect of 36 million uninsured Americans — who are currently self-rationing care, paying on sliding fee scales, or not paying at all — flowing into hospitals, clinics and outpatient facilities via subsidized insurance, mandated policies and more affordable options in the proposed insurance exchange.

Conservatively, those newly insured people will not only add millions of dollars more to hospital coffers in the short term but the potential for trillions in billable services over their lifetimes. [...]

Catholic institutions are uniquely bound by religious directives on care, effectively eliminating key reproductive health and end-of-life treatment that other institutions will provide to patients and bill to their insurance carriers.

Add those restrictions and compound it with two simple facts: 73 percent of the now uninsured are of reproductive age and the leading cause of death among people aged 15-44 is accidents.

In essence, the people most likely to benefit from the proposed public option and insurance exchange will undoubtedly be seeking the type of care Catholic hospitals refuse to provide as a matter of religious principle. And these prospective patients are young and will conceivably need care for many decades to come.

For the business arm of the Catholic church it's a theological and economic two-fer.

The bishops can extract abortion care from the private insurance benefits of millions of American women that are federally subsidized ten ways to Sunday (with the blessing of conservative lawmakers' corporate welfare earmarks) and they level the competitive playing field without having to revise its medical doctrine to modern standards of care. [...]

Further reading

“The War on Women”, Republicans in the House of Representatives are mounting an assault on women’s reproductive rights and access to essential health care. Editorial, New York Times, 26 February 2011.

Sharmila Devi, “Obama rescinds ‘overly broad’ Bush-era conscience rule”, The Lancet, Volume 377, Issue 9770, Page 981, 19 March 2011.  



1. Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition

2. Stupak of Michigan Amendment to H.R. 3962 (PDF), as reported by the House Committee on Rules, November 6, 2009. 

3. Jessica Mack, “The Onerous Toll of the Helms Amendment and What Obama Can Do To Change It”, Reality Check, 17 January 2012.

The 1973 Helms Amendment is reflected in the current regulations for US Aid: 

On some of the worldwide effects of the Helms Amendment, see: that this has had worldwide see: “Pivotal Positions: Transforming Abortion Provider Stigma”, RH Reality Check, 22 September 2011.

4. Robert Mickens, “Vatican blocks re-election of Caritas Internationalis chief”, The Tablet, 19 February 2011.

Last updated 19 January 2012

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