This is a dramatic departure from prevailing law, which sets out a commonsense baseline for emergency care in a key consumer protection that applies to all hospitals. The law, the Emergency Medical Treatment and Active Labor Act (EMTALA), applies to any hospital receiving funds under Medicare or Medicaid (effectively, all of them) and was signed into law by President Reagan to combat the widespread practice of “patient dumping”— hospitals’ refusal to treat low-income and uninsured patients who need emergency care.
As its name suggests, EMTALA reflects a particular concern for women in labor. Under the law, hospitals that cannot provide the care a patient requires must stabilize their condition prior to transferring them to another facility. This is truly a minimal obligation, and makes sense given that anyone – pregnant women included – must be able to seek care in an emergency from the closest hospital to them at the time.
That religious hospitals would jeopardize their patients’ lives rather than perform a medically necessary abortion is not mere speculation, it is documented fact. A 2008 article in the American Journal of Public Health examined numerous instances in which Catholic hospitals put patients’ lives at risk, as reported by the doctors who were forced to deny them care.
In one example, a woman 14 weeks pregnant who suffered ruptured membranes and was in the middle of a miscarriage was forced by the Catholic hospital to travel 90 miles to another hospital to complete the miscarriage. In another instance, a pregnant woman was already septic and hemorrhaging, and her doctor recommended a pregnancy termination. The Catholic hospital staff refused. Rather than treat the woman, the staff proposed moving her from the emergency room into a hospital bed, giving her a transfusion, and waiting for the fetus to die before helping the woman.
Another doctor reported that a woman, pregnant at 19 weeks, was “dying before our eyes” – she had a 106 degree fever and the whites of her eyes were filled with blood – but still the Catholic hospital refused to treat her until the fetus finally died. The woman barely survived after spending 10 days in the intensive care unit. The doctor, disgusted with the Catholic hospital’s policies that endangered patients, eventually quit his position to work at a nonsectarian medical center.
More recently, Bishop Thomas Olmsted a the staff of St. Joseph’s, a Catholic Hospital in Phoenix, Arizona, for performing an abortion for a 27-year-old mother of four who was 11 weeks pregnant. She was told by her doctors that if she brought the pregnancy to term, her chance of dying was “close to 100 percent.” Writing that the life-saving abortion constituted “cooperation in evil,” Bishop Olmsted not only excommunicated the nun who had worked for 30 years as a hospital administrator, but revoked the hospital’s Catholic affiliation.
When the Catholic bishops sought a broadened refusal provision during last year’s healthcare reform debate, lawmakers rightly refused. A right to deny care to anyone on the basis of religious or moral beliefs can far too easily intrude on the core goal of reform – to ensure that a basic standard of care is available to every American.
But this latest change goes much further than even those proposals would have. Because the proposed legislation would over-ride legal obligations under EMTALA, the new law would actually allow hospitals to deny care altogether – literally to do nothing in an emergency, including fail to stabilize and transfer.
Catholic religious officials have long asserted that refusal rights should permit this active neglect. They contend that women in this situation should be left “in God’s hands,” and, even, that it is preferable for a woman to die in childbirth than to “live the rest of her existence knowing” she had an abortion, as Father John Ehrich, Medical Ethics Director of the Phoenix Diocese, wrote about the Phoenix case. Until now, however, the law has helped to protect most patients from the dire consequences of this dogmatic view.
Access to abortion is a constitutional right – a truth that these debates over refusal disregard. Even putting this fundamental point aside, the notion that religious medical facilities could legally allow women to die from treatable conditions inside their doors cannot be permitted in a religiously pluralistic society. While religious hospitals are entitled to an official religious orientation, they must not be permitted to use their theology to jeopardize patients’ lives.
The happenstance of which hospital an ambulance rushes someone to in an emergency cannot be a game of Russian roulette. Moreover, in many areas of the country, religiously affiliated hospitals are the largest or only providers of care. Congress should immediately and decisively reject this frightening proposal to make clear that all patients’ medical needs are the first and only consideration for hospitals in an emergency.
Nancy Northup is president of the Center for Reproductive Rights.