Appeal to conscience clauses in the face of divergent practices among Catholic hospitals.

Conscience clauses are laws enacted by federal and state governments to protect health care providers from participating in those medical practices they consider morally objectionable. This study examines the practices of Catholic hospitals and their adherence to the Ethical and Religious Directives (ERD) for Catholic Health Care Services issued by the U.S. Conference of Catholic Bishops. If divergence of practice exists among Catholic hospitals, such diversity may pose judicial and political problems for providing protection under the conscience clauses. Catholic hospitals in seven states—California, Illinois, Indiana, New Jersey, New York, Texas and Washington—were studied to determine if diversity of practice existed in the provision of direct female sterilizations. Inpatient discharge data was requested for three years (2007-2009) from the 1,734 hospitals, secular and Catholic, within the states. Of these hospitals, 239 Catholic hospitals were identified of which 176 provided obstetric services. The records of these 176 hospitals were searched for those containing the diagnostic code from the ICD-9-CM coding system for sterilization for contraceptive management. Eighty-five or 48% of these hospitals provided a total of 20,073 direct sterilizations in violation of the ERD. An analysis of Catholic hospital systems owning hospitals within the seven state study area illustrated that 69.0% of the hospitals were members of 26 various Catholic hospital systems. Ten systems operating in the seven states also have hospitals outside the study area. Within these 10 systems, 64.2% of the hospitals in the study area performed direct sterilizations. An analysis of the Catholic dioceses in the study area revealed that 72.1% of the dioceses had hospitals which provided direct sterilizations. Thus, diversity of practice resulting from varied interpretations and applications of the ERD exists among hospitals, and within hospital systems and dioceses. An analysis of the conscience clauses illustrates that Catholic hospitals are in jeopardy of defending themselves against judicial challenges and could strip themselves of the ability to mount a political front to aid in defending the conscience clauses.Ph.D