It used to be Americans viewed Catholic hospitals and healthcare systems with universal respect and trust. They had no reason to do otherwise.

Founded in the nineteenth century by orders of nuns with a mission to care for the poor, Catholic hospitals grew and thrived in modern industrial medicine. Many became conglomerates and dominant sources of healthcare in cities and towns throughout the nation, especially in the Western United States. The trade association founded in 1915, the Catholic Health Association today represents 1200 Catholic health care sponsors, systems, facilities, and related organizations and services. Catholics and non-Catholics alike have considered Catholic Healthcare an unqualified good, delivering high quality medicine and serving their communities’ needs. It made little difference to most people whether their hospital was Jewish, Seventh Day Adventist, Episcopal or secular. Indeed, the image of selfless nuns running charitable institutions probably bestowed a brand advantage on the Catholic entities.

This is no longer the case.

A conservative theology and obsession with obedience have ruined the brand. Nowadays the phrase “Catholic hospital” is as likely to conjure images of unyielding bishops enforcing dogma on the irreligious as kindly nuns delivering succor to the suffering. Today most people realize that very few nuns actually run or work in Catholic hospitals. Knowledgeable people also know Catholic hospitals deliver no more charity care than their secular nonprofit counterparts.

Change came gradually, but high-profile power plays by the bishops recently pushed the brand onto a steep downward slide.

Activist Bishops

1. Two years ago Phoenix Bishop Thomas Olmsted excommunicated a prominent nun for allowing doctors to save a woman’s life by terminating her pregnancy. When the hospital stood by the decision not to let both mother and fetus die, Olmsted stripped the entire medical center of its Catholic affiliation. National commentators openly warned women with reproductive emergencies to avoid Catholic hospitals.

2. In February 2010 Bishop Robert Vasa revoked Catholic affiliation for St. Charles Medical Center in Bend, Oregon for providing tubal ligations in keeping with prevailing medical standards for the procedure.

3. The Catholic Health Association supported its member hospitals until the bishops extracted an admission that local bishops are the “authoritative interpreter” of permissible Catholic healthcare. The Association’s CEO publicly affirmed absolute power for local bishops to interpret the ERDs (Ethical and Religious Directives for Catholic Healthcare) and even to develop their own if they choose.

4. Last year a bishop in Spain declared the decision to remove food and water from a 90 year-old comatose woman an act of euthanasia. Describing the vegetative states as a chronic illness, he objected to laws allowing the family to follow what they knew to be her wishes.

5. Last June the US Conference of Catholic Bishops met in Seattle, reproached Compassion & Choices by name and denounced aid in dying as an end-of-life choice. Defying logic, the Conference asserted that adding a choice actually restricts choice and creates an illusion of freedom. More to the point of doctrinal enforcement, they called aid in dying “a grave offense against love of self” that breaks the bonds of love with God.

Blocked Expansion

Aggressive enforcement of dogma did not go unnoticed in communities where Catholic Hospitals sought to acquire or merge with secular ones. Entities resulting from unification with a Catholic hospital are always obligated to adhere to Catholic teaching and follow the bishops’ instructions for Catholic healthcare.

1. Two years ago the citizens of Sierra Vista, Arizona demonstrated for months against the proposed takeover of a secular hospital by a Catholic healthcare system, until hospital officials dropped the proposal.

2. Early this year the Attorney General and Governor of Kentucky blocked a bid by Catholic Health Initiatives to merge with publicly funded University Hospital.

Demands of the Marketplace

The enormous significance of these events became evident when Catholic Healthcare West, the fifth largest hospital conglomerate in the nation announced termination of its status as a ministry of the Catholic Church.

Renamed Dignity Healthcare, the 50 hospital system seeks to acquire additional hospitals and triple its size. The CEO readily admits that concerns about Catholic affiliation hampered his ability to grow. At the time he said the change to a nondenominational board would create “a tremendous opportunity that will help accelerate our growth.”

Oregon is the first state Dignity targets for expansion. In a subsequent blog I will examine what this means for end-of-life choice in the town of Ashland, where Dignity seeks to acquire the community hospital.

The clear meaning of Catholic Healthcare West’s transformation to Dignity Health is that “Catholic” is no longer a desirable brand in the marketplace for healthcare partnerships and medical services.

Truer but Fewer

Visiting Ireland in April, I chatted with a Catholic monk as he showed us architectural details of a medieval church. He bemoaned the drastic changes underway as the government wrests control of 95% of the nation’s public schools from the hierarchy of the Church. But he acknowledged the change is necessary as the church has become more conservative and the state more leery of its control. I ventured the opinion that the Vatican’s radical conservatism hardly seems a strategy for long-term growth. “That’s not the point,” he said. “Church leaders value those of ‘truer’ faith,” and they don’t mind that this retains fewer truly faithful adherents.

If the same principle holds for Catholic hospitals in the United States, Americans take heed. Institutions that retain their Catholic affiliation and continue to embrace their ministerial role may be those most entrenched in Catholic moral teaching. Bucking imperatives of the market, they may be most inclined to apply the Ethical and Religious Directives strictly and hew narrowly to services and healthcare decisions the local bishop deems consistent with church doctrine. You can affirm, with our Sectarian Healthcare Directive, that no facility’s dogma should override your end-of-life choices, and I encourage you to do so. Because without vigilance, patients and doctors may have less influence than the bishop over healthcare decisions made inside their hallowed walls.