Rapid advancements in medical practice and technology have made some health care decisions complicated. For example, what do we do when a loved one becomes unresponsive in a coma or perhaps is diagnosed with persistent vegetative state (PVS), now sometimes called unresponsive wakefulness syndrome? If there seems to be no hope of recovery, is it morally licit to withdraw nutrition and hydration and allow them to die “naturally”? Or what medical assistance can an infertile couple accept to morally try to conceive a child?
These are only a couple of the many questions one might face when difficult situations arise during a health care crisis at the beginning or end of life—and in the middle too. Not all situations have straightforward answers, so well-regarded Catholic experts in bioethics or medical ethics should always be consulted if there is a question.
The United States Conference of Catholic Bishops (USCCB) began to formally address ethical issues in health care in 1981 with a statement called Health and Health Care that drew deeply from the Catholic moral tradition. Now, almost forty-five years later, the USCCB has recently published the seventh edition of its Ethical and Religious Directives for Catholic Health Care Services (ERDs). This newest version includes important updates to provide moral guidance for new issues that have arisen since the last revision was approved in 2018.
Catholic health care in the US generously responds to Jesus’s command to heal the sick as integral to evangelization (CCC 1505–1506). Currently, Church ministries sponsor 659 hospitals in the US and about 1,520 long-term care facilities. In 2022, Catholic health care provided about $14.6 billion in “community benefit”—a combination of charity care and unreimbursed expenses incurred by coverage gaps in Medicaid and other programs. Catholic health care provides between 15 and 17 percent of all health care services in the US.
The first obligation Catholic health care has is to protect the person from any procedure that would violate that person’s ontological dignity.
The rapidly changing landscape in the delivery of care, costs, and reimbursements has resulted in consolidations, mergers, and cooperative agreements negotiated internally between Catholic hospitals and health care systems, as well as externally between Catholic and secular institutions. In all these arrangements, contractual agreements between secular and Catholic institutions must be scrutinized to remove any possibility of scandal and to ensure Catholic identity is preserved in the delivery of care and range of services provided. Part 6 of the ERDs addresses these challenges:
When considering a collaboration, Catholic health care administrators should seek first to establish arrangements with Catholic institutions or other institutions that operate in conformity with the Church’s moral teaching. It is not uncommon, however, that arrangements with Catholic institutions are not practicable and that, in pursuit of the common good, the only available candidates for collaboration are institutions that do not operate in conformity with the Church’s moral teaching.
Part 6 goes on to lay down the moral principles by which such cooperative agreements must be evaluated.
Of more direct interest to individuals are Parts 3, 4, and 5. These sections address the professional–patient relationship and issues that arise at the beginning and end of life. It is in these areas that the seventh edition has made significant revisions and clarifications to respond to newer developments that impact the care that some may be offered.
Gender Incongruence or Dysphoria
Part 3 of the ERDs addresses the newest moral challenge to human dignity—requests for so-called gender-altering interventions. The bishops address the morality of such services directly, but underlying the topic is a critical constitutional challenge facing Catholic health care: whether Catholic institutions that receive federal funding—in this case Medicare/Medicaid—can yield to legal or political pressure to provide mutilating drugs and procedures. There have been at least seven lawsuits filed against Catholic hospitals since 2015 by individuals who sought damages from the Catholic institution for refusing to assist them in their goal of “transitioning.” Unfortunately, one of these lawsuits was ironically filed against a Catholic hospital by a detransitioner who sued the hospital for rushing her into a double mastectomy, allegedly violating their “duty of reasonable care.”
With this case, we can see the urgent need for the bishops to clarify the moral guardrails for Catholic hospitals in addressing this newest threat to human dignity. With a reference to Dignitas Infinita, the 2024 declaration from the Dicastery for the Doctrine of the Faith, the bishops stated, “When the health care professional and the patient use institutional Catholic health care, they also accept its public commitment to the Church’s understanding of and witness to the dignity of the human person” (introduction to Part 3). In other words, the first obligation Catholic health care has is to protect the person from any procedure that would violate that person’s ontological dignity. Unfortunately, that seems to be what happened at this hospital in Milwaukee. If Catholic health care is divided on such a critical issue as this, there is, at best, a weak legal defense for a hospital sued for refusing to do these procedures.
ERD 27 states that even “if a patient or a patient’s surrogate requests a medical intervention that is not in accord with Catholic teaching, health care professionals may not refer the patient to another professional for the purpose of obtaining that intervention.” ERDs 29 and 30 specifically reference gender incongruence, then state what is required for a morally licit intervention to suppress or remove parts of the body. But, of course, morally illicit medical interventions are not limited to only this issue.
Physician-Assisted Death
New York recently became the thirteenth US jurisdiction to allow physician-assisted death when Governor Hochul signed its Medical Aid in Dying Act into law on February 6. The USCCB provided an important clarification for Catholic health care in ERD 60 in the context of suicide:
If a patient expresses an intention to commit suicide by Voluntarily Stopping Eating and Drinking (VSED), he or she should be informed that the Catholic health care service will not facilitate this course of action. Rather, health care professionals should do what they can, in a way that respects the patient’s freedom, to dissuade the patient from this course of action. They should continue to provide appropriate pain management while avoiding immoral cooperation.
It is important to clarify that the directive isn’t mandating nutrition and hydration under any and all circumstances. ERD 58 states, “This obligation extends to patients in chronic and presumably irreversible conditions . . . who can reasonably be expected to live an indeterminate amount of time if given such care.” However, it may become “morally optional when they cannot reasonably be expected to prolong life or when they would be ‘excessively burdensome for the patient or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed.’”
The bishops reaffirm the value of palliative care to address suffering through pain relief, but they also stress the Church’s obligation to accompany the dying person to avoid the added suffering of loneliness or isolation they may experience in their sickness.
Reproductive Technologies
The rapid development of new reproductive technologies is an area that deserves careful and critical commentary from the Church. There is perhaps no more grave threat to human dignity than medical interventions that separate the marital act from the conception of children. Inseparable from these procedures is the disregard for the sanctity of life that occurs throughout the technical processes that engender and then screen human embryos in laboratories to identify “flaws” in the product.
They make it very clear that the destruction or cryopreservation of human embryos that may result from these immoral in vitro fertilization procedures is prohibited.
The introduction to Part 4 provides a beautiful summary of the Church’s teaching on marriage and the begetting of children. After acknowledging that some new technologies have the potential for good, the bishops state a principle our society often overlooks: that “one cannot assume that what is technically possible is always morally right.”
In general, any process that involves the engendering of embryos outside the body of the mother is morally illicit. New to the seventh edition are ERDs 39, 40, and 41, in which the bishops add to this injunction, “Techniques of assisted reproduction also must not involve the cryopreservation or destruction of human embryos or the cryopreservation of human gametes for the purpose of immoral methods of reproduction.” They make it very clear that the destruction or cryopreservation of human embryos that may result from these immoral in vitro fertilization procedures is prohibited.
This has been a brief overview of additions made to the most recent version of the USCCB’s Ethical and Religious Directives for Catholic Health Care Services. The ERDs don’t stand alone as the sole expression of the US bishops on the ethical delivery of health care but are rather universal principles. Like their 1981 precursor, the ERDs provide a concise summary of the Church’s deep reflection over many years on certain medical interventions; they serve as guidance for Catholic health care to promote human dignity and flourishing and to protect all persons from innovations that ultimately harm the bodily and spiritual integrity of the human person.
The ERDs are not intended to be an exhaustive commentary on the moral practice of medicine, but they provide a valuable and accessible summary to guide Catholic health care in a proper “understanding of the nature of the human person, of human acts, and of the goals that shape human activity.” Thus, Catholic health care may remain faithful to its mandate from the Lord “to cure every disease and illness” (Matt 10:1).