2011 closed with good news out of Kentucky. On Friday Governor Steve Beshear refused to approve a Louisville hospital merger that threatened patient choice. Compassion & Choices, MergerWatch, the National Women's Law Center and other national advocacy organizations joined local activists to raise constitutional and public policy questions regarding potential threats to end-of-life and reproductive care. In announcing his decision, Gov. Beshear noted “significant legal and policy concerns.”

Religious doctrine limits patient choice in over 600 of our nation’s hospitals, nursing homes and HMOs. When a Catholic healthcare institution merges with a non-sectarian one, the Ethical and Religious Directives for Healthcare (ERDs) invariably control care provided by the merged entity. Compassion & Choices is committed to joining patient rights advocates to oppose the imposition of religious restrictions wherever the threat arises.

This proposal ceded control of Louisville’s only public hospital to a Catholic healthcare company (St. Joseph Health System), and placed healthcare decisions in the hands of the local bishop and the United States Conference of Catholic Bishops. We applaud Governor Beshear for exercising good stewardship and ensuring that University Hospital (UNL) serves the public interest and needs for future generations of Kentucky citizens. “If this merger were allowed to happen,” Beshear said, “UNL and the public would have only indirect and minority influence over the new statewide network’s affairs and its use of public assets.”

Despite assurances from architects of the merger, loss of public influence in healthcare could have disastrous consequences for the people who depend on publicly funded healthcare. The people could never again rely on their public institution to place the highest priority on community needs. The ERDs that govern Catholic healthcare enforce Catholic doctrine. Staff and administrators must balance that doctrine, when possible, with community needs. Some options remain forbidden, no matter how great or pressing the need may be. This balance can leave the community with uncertain and unpredictable service.

A doctor at St. Joseph Hospital – a defender of St. Joseph’s Catholic identity – wrote of the confusing and contradictory statements made by hospital officials:

An Oct. 24 (Louisville) Courier-Journal article noted that on June 14, U of L Dean Halperin, "made a promise that we'll respect the ERDs of the Catholic Church," and on June 30, University Hospital CEO James Taylor stated, "we've also made the commitment that by joining the network with (SJHS) ... we will adhere to the ERDs."

Now that a merger might be imminent, a different stance has surfaced. The merger partners state in an Oct. 19 Metro Board of Health (BOH) release that University Hospital "will not become a Catholic hospital and will not be required to follow the ERDs."

The Courier-Journal calls this "legal mumbo-jumbo." Nonetheless, University Hospital spokesman David McArthur would not concede that it was a position change, but "an evolution of our explanation."

Without governing authority, UNL and the citizens it serves could be forever tossed like a kite upon the changing winds of “evolving explanations” and changes in Church policy. In recent decades, the Vatican has become more conservative and U.S. bishops have required stricter obedience from Catholic healthcare institutions. No one can predict how Catholic doctrine or enforcement may change in the future, and once a public institution is lost, its accountability to the public welfare is lost forever.

So we welcome the new year with a celebration of effective community advocacy and a toast to elected officials who act in the public interest. Kentucky Reps. Mary Lou Marzian and Tom Burch helped inform the governor of advocates’ concerns and urged him to stand up for all Kentucky residents and their right to comprehensive healthcare.

We remain watchful. Announcing his decision, the governor said “… I have determined that this proposed transaction is not in the best interest of the commonwealth …” The emphasis was his. Compassion & Choices will resist any proposal – in Kentucky or elsewhere – that fails to safeguard patient rights to a full range of end-of-life healthcare choices