When Care Is Contingent on Control: Power, Trauma, and the Catholic Healthcare System
“When care is controlled by doctrine instead of compassion, suffering becomes inevitable.” - Mary Coughlin
When Care Is Contingent on Control: Power, Trauma, and the Catholic Healthcare System
Catholic healthcare’s use of Ethical and Religious Directives (ERDs) creates a unique and often unspoken power dynamic in healthcare. These directives dictate the type of care clinicians are allowed to provide, often at odds with compassion-based, patient-centered care. The result? Patients, especially women, face unnecessary pain, suffering, and risk. This post exposes the human cost of prioritizing doctrine over compassion.
What Are ERDs?
Ethical and Religious Directives (ERDs) are religious guidelines that govern care in Catholic healthcare facilities. They dictate what is "permissible" in care, particularly around issues like contraception, miscarriage management, abortion, and end-of-life decisions. Unlike clinical best practices, which prioritize evidence-based care, ERDs follow religious doctrine that can limit care options available to patients and restrict clinicians' ability to act according to their professional judgment.
How Do ERDs Impact Patients?
Patients in Catholic hospitals often experience limited access to essential care compared to what they would receive in a non-religious facility. For example:
Miscarriage Management: Women experiencing a miscarriage may be denied timely medical interventions, such as a dilation and curettage (D&C), if a fetal heartbeat is still present. Instead, they are told to “wait it out” until there is no detectable fetal heartbeat, causing unnecessary physical and emotional trauma.
Denied Access to Contraception and Sterilization: Even when contraception is a medical necessity, ERDs prohibit it, impacting women’s autonomy over their reproductive health.
Abortion Care: Life-saving abortion procedures are frequently denied, even when a patient’s life is at risk, leading to unnecessary suffering and, in some cases, catastrophic health outcomes (this is certainly compounded by the current situation in the U.S.).
These restrictions not only compromise the well-being of patients but also erode trust in the healthcare system. Patients often don’t know they’re in a Catholic facility or that their options for care are being controlled by religious doctrine until it’s too late.
Stories of Impact
Let’s make this real. Imagine this: A woman is 10 weeks pregnant when she starts bleeding. She goes to the nearest hospital, not knowing it's a Catholic facility. An ultrasound reveals the baby has no chance of survival, but the fetal heartbeat is still present. Instead of offering a D&C, doctors tell her she has to wait — wait for the heartbeat to stop on its own. Days go by. The physical pain worsens. The emotional pain? Unimaginable. She waits at home, fearing infection or worse. If she had gone to a non-Catholic facility, she would have received immediate, compassionate care.
These stories aren’t rare — they are far too common. They expose the harsh reality of delayed and denied care in Catholic healthcare facilities. For many, it is the only available healthcare option in their community.
Impact on Clinicians
It’s not just patients who are affected. Clinicians experience moral injury when their ethical obligations to care for patients are in direct conflict with ERDs. Imagine being a nurse, doctor, or healthcare provider in a Catholic hospital, knowing what the patient in front of you needs, but being told, “We can’t do that here.”
Moral injury occurs when clinicians are forced to violate their personal and professional values. They are put in an impossible position: follow the ERDs or act on their ethical duty to the patient. For many, this leads to feelings of guilt, shame, and professional disillusionment. Over time, these experiences contribute to burnout, compassion fatigue, and departure from the profession.
Public Health Implications
The power of Catholic healthcare extends beyond the walls of its hospitals. As one of the largest healthcare providers in the United States, Catholic healthcare has significant influence, particularly in rural and underserved areas where it may be the only care option. This raises questions about equitable access to care and the ethical implications of allowing religious doctrine to dictate care.
In some communities, Catholic hospitals are the only hospital available. This means families have no choice but to receive care under ERDs, which can restrict life-saving treatments like abortion, miscarriage management, and contraception. Equitable access to healthcare should not be dependent on geography, wealth, or religious affiliation.
When doctrine dictates care, it creates two tiers of healthcare: one for those in secular hospitals and another for those under the control of religious directives. The ripple effects of this inequity are profound, and they raise urgent questions about patient rights, access to care, and the role of power in healthcare.
Call to Action (CTA)
If Catholic healthcare can control care, what other unseen forces shape our experience in healthcare?
Next up in this series, we’ll explore how medical hierarchies and positional power affect the experience of clinicians, parents, and babies alike. Stay tuned for Part 3.
Reflection Prompt
Have you ever been impacted by a healthcare decision that was based on policy or doctrine, rather than compassion or care? How did it shape your view of healthcare? Drop your reflections below — your story matters.
Take care and care well,
Mary
