The Dangers of Catholic Healthcare Restrictions

Opposition Notes: The Ethical and Religious Directives for Catholic Healthcare

This is the first installment of our series on how the bishops’ religious directives compromise healthcare and religious freedom. 

Founded by Catholic sisters and nuns seeking to serve the most marginalized of society, Catholic healthcare has grown into a massive industry. Every hospital and healthcare institution labeled as “Catholic” — and even some that aren’t — is subject to a set of religious rules called the Ethical and Religious Directives for Catholic Health Services (ERDs). These 77 directives dictate the required behavior of every employee of a Catholic health institution, regardless of their religious convictions or lack thereof. The laundry list of banned or severely restricted healthcare includes abortion, pregnancy loss treatment, contraception, sterilization, IVF, end-of-life care, and gender-affirming care.  

The worst part? Doctors don’t publish these directives. They’re issued by the U.S. Conference of Catholic Bishops, who dictate what medical procedures can be performed at Catholic hospitals, regardless of what doctors recommend or patients need. There is no public process for medical review or update based on medical advancements, or anything else that could improve care for patients. We usually find out just a few weeks — if not days — in advance if the bishops plan to discuss new guidance at one of their semi-annual meetings.  

Take the case of Lyndsay, a pregnant Missouri resident who was in severe pain and bleeding during a miscarriage. Lyndsay, understandably, went to the nearest hospital — a Catholic one. Once there, Lyndsey went through abdominal and vaginal scans that confirmed the fetus had no cardiac activity and that Lyndsay’s cervix hadn’t opened. Because of the Catholic hospital’s restrictions, a physician assistant said they couldn’t provide a standard treatment: medication, oftentimes mifepristone and misoprostol, which can be used to cause abortions and aid the miscarriage process. “I was pretty shocked,” Lyndsay told Catholics for Choice’s magazine, Conscience. “Not having timely access to the medication can lead to septic infections and other potentially deadly issues.” The Catholic hospital discharged Lyndsay, who had to drive to a Planned Parenthood in another state. Lyndsay, who was raised Catholic, felt “shocked that a whole profession built around helping people could deny people in need.”  

Fortunately, Lyndsay survived this injustice. Others are not around to bear witness to what they endured. In 2024, 18-year-old Nevaeh Crain died of pregnancy complications after visiting the emergency room three times. Media coverage focused on Texas’ abortion ban as the primary reason for her delayed care. Few acknowledged that the hospital she died in, Christus Southeast Texas St. Elizabeth, is a Catholic facility. We’ll likely never know whether the ERDs factored into hospital staff members’ care decisions, but one thing is clear: In Catholic hospitals, abortion bans have existed far longer than many state-wide restrictions. 

Under the ERDs, patients aren’t the only ones who suffer. Stuck in an impossible situation, providers and staff members at Catholic hospitals must choose between patients’ lives and their jobs — or even their spiritual status in the church. One of the most famous examples of this is the 2009 case of Sister Margaret McBride, RSM, an ethics committee member at St. Joseph’s Hospital and Medical Center in Phoenix, Arizona. Sister McBride approved a lifesaving abortion for a 27-year-old mother of four who, at 11 weeks pregnant, was experiencing cardiogenic shock and severe pulmonary hypertension. The patient survived. The Diocese of Phoenix, then led by Bishop Thomas Olmsted, said Sister McBride “admitted this directly to Bishop Olmsted” and “automatically excommunicated herself.”  

Catholic theologians and bioethicists grappled with the case, particularly as it related to the principle of double effect, a moral concept acknowledging that some actions may cause two results: one good (saving the patient’s life) and one bad (causing an abortion, in the eyes of the church, at least). Applying this principle, Directive 47 permits “operations, treatments, and medications that have as a direct purpose the cure of a proportionally serious pathological condition of a pregnant woman… even if they will result in the death of the unborn child.” Catholic theologian M. Therese Lysaught argued convincingly that the procedure used to save the 27-year-old patient’s life was not to remove the fetus, but rather to remove the placenta to halt the patient’s hypertension. The loss of the fetus was an indirect consequence of the abortion, and therefore, morally acceptable even within the ERDs’ restrictions. 

After a multi-year conflict that involved the removal and later reinstatement of St. Joseph’s church affiliation, Sister McBride was reinstated in the church and rehired to a new position in the hospital.

In 2024, she retired after 37 years of service with much celebration for the lives she saved. Other patients may not be so fortunate as to have a courageous woman like Sister McBride on the medical ethics board deciding their fate. 

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How has Catholic healthcare impacted you? If you have an experience you’d like to share (including anonymously), please visit The Overreach Monitor’s Tipline. Please reach out if you are… 

• Someone who tried to access care at a Catholic healthcare institution  

• A healthcare provider whose ability to provide care was restricted 

• A student on a Catholic campus who couldn’t access care 

• An advocate who has resisted mergers in your community 

• Someone who wants to share how they feel about Catholic healthcare restrictions

   

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These horrifying healthcare denials at Catholic hospitals aren’t isolated incidents: They’re becoming all too common. In the U.S., 4 of the 10 largest healthcare systems are Catholic. This leaves women of color, people in rural areas, people with disabilities, and low-income individuals with few options. In 2024, KFF HealthNews reported that for 800,000 patients in the U.S., the only birth hospitals within a one-hour drive are Catholic or Catholic-affiliated. Many people assume that in our privatized, market-driven healthcare system, competition will ensure that patients have choices. In our profoundly broken healthcare system, choice is an illusion. Someone experiencing a medical emergency doesn’t have time to analyze alternative hospitals: You go where the ambulance takes you, and increasingly, that’s a Catholic healthcare institution bound by the bishops’ restrictions in the ERDs.  

But hospitals don’t even have to be Catholic to fall prey to the ERDs: If a large healthcare conglomerate purchases a religiously unaffiliated hospital, the merger can leave providers scrambling to understand the new theological restrictions they are subject to. If you’re not paying close attention to mergers in your area, your primary hospital might suddenly be required to prioritize religious doctrine over doctors without you even realizing it. Even explicitly Catholic hospitals can be tough to identify: A 2019 study in The Journal of the American Medical Association found that only 79% of hospital websites stated their Catholic affiliation. Worse yet, only 24% of the hospital websites mentioned the ERDs. 

That’s precisely why Catholics for Choice launched “Is Your Healthcare Compromised?”, a first-of-its-kind interactive tool that helps determine the likelihood that your healthcare institution is subject to Catholic restrictions. Created using analysis of multiple studies on commonalities between Catholic healthcare institutions, it’s the type of resource you can expect from The Overreach Monitor.

The Ethical and Religious Directives are the very reason Catholic healthcare is dangerous for anyone who could become pregnant, but the ERDs also limit care in other areas. In this Catholic healthcare series, we’ll dive into the ERDs to discover how the Catholic bishops both explicitly and ambiguously restrict medical care. We’ll also talk about the particular threat Catholic healthcare institutions pose to LGBTQIA+ communities and what we can expect to see next from the bishops. Thanks for joining us on this investigation.