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Bishops clarify directives for Catholic hospitals:

"Cooperation" with providers of abortion, euthanasia, sterilization forbidden to Catholic health care services

By Helen Hull Hitchcock

ATLANTA - June 15. The Catholic bishops of the United States, at their semi-annual meeting held in Atlanta, unanimously approved a set of modifications to update and clarify their 1995 directives for Catholic hospitals.

The modifications respond to recent and significant changes in the management of Catholic health care facilities because of corporate mergers with secular institutions.

The modification to the earlier version of Ethical and Religious Directives states that "Catholic partners should avoid entering into partnerships that would involve them in cooperation with the wrongdoing of other providers", and specifically forbids "intrinsically immoral" actions such as abortion, euthanasia and sterilization.

Another major change from the current version is the elimination of a problematical appendix on "cooperation" with evil that gave the concept a "proportionalist" interpretation that would permit Catholic hospitals to "cooperate" with other health care providers if the Catholic institutions were under "duress". This interpretation could be used to justify collaboration with providers that performed intrinsically evil acts such as abortion, euthanasia and sterilization. The revised directives close this loophole. "Duress" cannot apply to institutions.

The revision was the result of conversations and consultations of the bishops working group with members of the Catholic Health Association [CHA] and members of the Congregation for the Doctrine of the Faith [CDF] during the past two years. According to Archbishop Daniel Pilarczyk of Cincinnati, a compromise was eventually reached which is acceptable to both the CHA and the CDF.

The amended directives appear below:

# 69 "If a Catholic health care organization is considering entering into an arrangement with another organization that may be involved in activities judged morally wrong by the Church, participation in such activities must be limited to what is in accord with the moral principles governing cooperation."

# 70 "Catholic health care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, and direct sterilization."

A footnote to #70 quotes a 1975 reply of the CDF to a question on "cooperation":

"Any cooperation institutionally approved or tolerated in actions which are in themselves, that is, by their nature and condition, directed to a contraceptive end ... is absolutely forbidden. For the official approbation of direct sterilization and, a fortiori, its management and execution in accord with hospital regulations is a matter which, in the objective order, is by its very nature (or intrinsically) evil" (ellipsis in footnote).

#71 "The possibility of scandal must be considered when applying the principles governing cooperation. Cooperation, which in all other respects is morally licit, may need to be refused because of the scandal that might be caused. Scandal can sometimes be avoided by an appropriate explanation of what is in fact being done at the Catholic health care facility in question. The diocesan bishop has final responsibility for assessing and addressing issues of scandal, considering not only the circumstances in his local diocese but also the regional and national implications of his decision."

A footnote to #71 gives a description of "scandal" quoted from the Catechism of the Catholic Church: "Scandal is an attitude or behavior which leads another to do evil" [no. 2284]; "Anyone who uses the power at his disposal in such a way that it leads others to do wrong becomes guilty of scandal and responsible for the evil that he has directly or indirectly encouraged" [no. 2287].

#72 "The Catholic partner in an arrangement has the responsibility periodically to assess whether the binding agreement is being observed and implemented in a way that is consistent with Catholic teaching".

In the brief discussion of the modifications, some bishops expressed concern that the "moral principles governing cooperation" are not described more fully in the Directives. Apparently, in eliminating the theological defective appendix on "cooperation", the committee judged that replacing it with another could become a contentious issue. Archbishop Pilarczyk said that the committee's proposal for modification had achieved an agreement between the CHA and the Holy See, and while it was theoretically possible for the bishops to amend it further, this might put its accepance at risk.

At a press conference after the revisions were accepted by unanimous voice vote of the bishops, Archbishop Pilarczyk explained "duress" to reporters. If someone puts a gun to my head and I give him my wallet and he uses the money to buy drugs, he said, my cooperation with evil would be under 'duress'. But only individuals can act under duress, he stressed. Institutions, (such as hospitals) even those that may suffer from economic "inconvenience" from not cooperating with a corporation that commits wrongful acts, are not capable of being placed under "duress", he explained.

Archbishop Pilarczyk and Bishop Donald Wuerl of Pittsburgh, were the bishops on the working group to clarify the directives, assisted by Father Augustine DiNoia, OP, former director of the secretariat of the Bishops' Committee on Doctrine, and Dr. James LeGrys.

The changes will be reflected in a new edition of Ethical and Religious Directives for Catholic Health Care Services, which is available on the web site of the bishops' conference.