Sarah Mitchell
The Catholic Church is the largest non-government provider of health care services in the world, with around 5,500 hospitals globally. In the US, Catholic hospitals are represented by the Catholic Health Association of the United States, which includes more than 600 hospitals. Catholic hospitals are bound by rules passed down by bishops that limit the kind of care that can be accessed, including prohibitions on abortion, contraception, and sterilization. As a result, many patients are opting to research hospitals in advance to understand their religious affiliations and any resulting restrictions on care.
| Characteristics | Values |
|---|---|
| Religious Directives | Catholic hospitals operate under the Ethical and Religious Directives published by the U.S. Conference of Catholic Bishops. |
| Prohibited procedures | Abortion, contraception, physician-assisted suicide, sterilization, IVF, surrogacy, embryonic stem-cell research, gender reassignment-related care |
| Religious names | Names like St. Joseph, Avera, or Dignity |
| Religious symbols | Crosses, crucifixes, religious statues, icons, or pictures |
| Religious services | Mass, prayers, or blessings offered to patients and staff |
| Religious staff | Nuns, priests, or other religious personnel working in the hospital |
| Religious ownership | Owned or affiliated with a Catholic diocese, religious order, or organization |
| Religious funding | Receipt of funding from Catholic organizations or religious orders |
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What You'll Learn
Catholic hospitals restrict reproductive care
The Catholic Church is the largest non-government provider of health care services in the world, with around 5,500 hospitals. In the US, the number of Catholic-sponsored or -affiliated acute-care hospitals increased by 16% between 2001 and 2011, while all other types of non-profit hospitals declined. In 2011, 10 of the 25 largest health systems in the nation were Catholic-sponsored. This means that if you face a medical complication, you have a one in ten chance of landing in a Catholic hospital.
Catholic hospitals adhere to religious directives issued by the U.S. Conference of Catholic Bishops, which prohibit a range of reproductive health services, including contraception, sterilization, many infertility treatments, and abortion care, even when a woman's health or life is in danger. These directives also often restrict the ability of hospital staff to provide patients with full information and referrals for care that conflict with religious teachings.
For example, in Iowa, which has the highest share of Catholic or Catholic-affiliated hospitals among all states, a nurse midwife at MercyOne, one of the largest health systems in the state, regularly tells pregnant patients that the hospital cannot perform tubal sterilization surgery to prevent future pregnancies or refer patients to other hospitals that do. In response to questions, a MercyOne spokesperson said that its providers "offer care and services that are consistent with the guidelines of a Catholic health system."
In another case, a woman named Tamesha went to her local hospital in lower Manhattan, which was historically secular but had recently been acquired by a large Catholic health care system, when her water broke at eighteen weeks of pregnancy. The hospital sent her home multiple times, telling her there was nothing it could do, even though there was almost no chance the fetus would survive and attempting to continue the pregnancy would put her health and life at risk. Tamesha did not receive the information or care she needed because her local hospital was bound by the Ethical and Religious Directives for Catholic Health Care, issued by the U.S. Conference of Catholic Bishops.
The spread of Catholic-owned healthcare facilities has raised concerns about complicating access to reproductive care, especially in the post-Roe era. In 10 states, more than 30% of acute care beds are in Catholic hospitals, and these hospitals must abide by the Catholic Church's doctrine, which includes restrictions on abortion, sterilization, and contraception. In some cases, these restrictions have led to lawsuits, such as the one filed by the ACLU of Illinois after a woman was denied long-acting and reversible birth control at a Catholic facility in Chicago.
While Catholic hospitals argue that their restrictions on reproductive care are rooted in their reverence for life, reproductive rights advocates argue that the lack of choice has negatively impacted rural and low-income communities where patients cannot easily transfer to secular institutions. Additionally, many patients are unaware of the restrictions as hospital administrators typically don't outline the services they do not offer, and state laws often shield hospitals from lawsuits for not performing procedures they object to on religious grounds.
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Religious directives govern Catholic hospitals
The Catholic Church is the largest non-government provider of healthcare services in the world. It has around 5,500 hospitals, with 65% of them located in developing countries. The Church's involvement in healthcare is ancient, with Jesus Christ instructing his followers to heal the sick. The Benedictine rule holds that "the care of the sick is to be placed above and before every other duty, as if indeed Christ were being directly served by waiting on them".
The Ethical and Religious Directives for Catholic Health Care Services (ERDs) are directives issued by the United States Conference of Catholic Bishops to govern Catholic health facilities. These directives present "a theological basis for the Catholic health care ministry" and govern the way healthcare is delivered in Catholic health facilities, including hospitals, clinics, and managed care organizations. The directives prohibit a range of reproductive health services, including contraception, sterilization, many infertility treatments, and abortion care, even when a woman's health or life is in danger. They also often restrict the ability of hospital staff to provide patients with full information and referrals for care that conflict with religious teachings.
The expansion of Catholic hospitals has left patients at the mercy of the church's religious directives, which are often at odds with accepted medical standards. For example, in the case of Tamesha Means, who went to her local hospital after her water broke at 18 weeks of pregnancy, she was sent home multiple times, even though continuing the pregnancy put her health and life at risk. The hospital was bound by the Ethical and Religious Directives and did not provide her with the information or care she needed, resulting in an infection.
The updated directives in 2018 also require that representatives of Catholic health institutions who serve on governing boards of non-Catholic institutions that do not follow Catholic ethical principles should make their opposition to immoral procedures known and not consent to any decisions connected with such procedures. Additionally, Catholic entities are prohibited from establishing another entity to "oversee, manage, or perform immoral procedures." The 2018 updates are intended to better manage the growing number of Catholic hospital mergers and extend the reach of Catholic doctrine.
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Catholic hospitals receive taxpayer funding
The Catholic Church is the largest non-government provider of healthcare services worldwide, with around 5,500 hospitals, 18,000 clinics, and 16,000 homes for the elderly and those with special needs. In 2010, the Church managed 26% of the world's healthcare facilities, and this number has grown significantly since then. In the US, the number of Catholic hospitals has increased by 29% from 2001 to 2020, while the number of all other hospitals fell by nearly 14%. As a result, many communities now rely solely on Catholic hospitals for urgent healthcare needs.
The Church's involvement in healthcare is rooted in its religious beliefs and values. Jesus Christ, whom the Church holds as its founder, instructed his followers to heal the sick. Early Christians were noted for tending to the sick and infirm, and their emphasis on practical charity led to the development of systematic nursing and hospitals. However, the Church's moral stance against contraception, abortion, and certain reproductive health services has been a source of controversy. Catholic hospitals adhere to the Ethical and Religious Directives for Catholic Health Care Services (ERDs), which allow them to refuse or restrict certain medical procedures and treatments that conflict with their religious teachings.
The impact of Catholic hospitals receiving taxpayer funding is a matter of debate. On the one hand, Catholic hospitals provide support to millions of people, including those with HIV/AIDS and in developing countries. They have been praised for their charitable work and contribution to global health initiatives. On the other hand, critics argue that Catholic hospitals should honour the full scope of medical needs of the public, rather than imposing their religious beliefs on patients. The restrictions on reproductive health services and end-of-life care have led to concerns about access to comprehensive healthcare, especially in areas where Catholic hospitals are the only option.
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Catholic hospitals are expanding
The Catholic Church is the largest non-government provider of health care services in the world, with around 18,000 clinics, 16,000 homes for the elderly and those with special needs, and 5,500 hospitals, 65% of which are located in developing countries. The Church's involvement in healthcare is rooted in its ancient origins, with Jesus Christ instructing his followers to heal the sick.
In recent years, Catholic hospitals in the United States have been expanding their reach. Between 2001 and 2011, the number of Catholic-sponsored or -affiliated acute-care hospitals increased by 16%, while all other types of non-profit hospitals declined. As of 2016, the number of Catholic-owned or affiliated hospitals in the US had grown by 22% since 2001, with one in six acute care beds in a hospital connected to the Church. This expansion has continued, with a 2024 report noting that 15.8% of all short-term acute care hospitals in the US are Catholic-owned or affiliated.
This growth is driven by mergers, acquisitions, and partnerships with secular hospitals and networks. For example, in the Albany, NY area, St. Peter's Health Partners, a Catholic network, merged with the secular Ellis Medicine, resulting in religious directives influencing the care provided at Ellis Hospital and the Bellevue Woman's Center. This expansion of Catholic health systems has led to concerns about limited access to reproductive health care services, including contraception, sterilization, abortion care, and gender-affirming care.
The expansion of Catholic hospitals has also raised ethical concerns regarding the denial of essential health care. Catholic hospitals follow religious directives, such as the Ethical and Religious Directives for Catholic Health Care, issued by the U.S. Conference of Catholic Bishops, which prohibit a range of reproductive health services. As a result, patients seeking care that conflicts with these directives may face challenges in accessing the services they need.
The impact of this expansion is significant, as it affects not only the availability of certain medical procedures but also the information patients receive. In some cases, Catholic hospitals may restrict their staff from providing patients with full information and referrals for care that conflict with religious teachings. This expansion highlights the ongoing debate between religious beliefs and medical standards in healthcare and the potential impact on patients' rights and access to care.
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Catholic hospitals may not be upfront about restrictions
A 2019 study published in JAMA analyzed the websites of 646 hospitals listed in the Catholic Health Care directory in 2017. Only a quarter of the hospitals cited the Ethical and Religious Directives (ERDs) on their website, and just 15% provided a direct link. Less than a third of the hospitals included in the analysis specified how religious affiliation might influence patient care, such as women's reproductive services or end-of-life care.
According to the study's senior author, Dr. Maryam Guiahi, an associate professor of obstetrics and gynecology at the University of Colorado School of Medicine, "many patients do not anticipate religious healthcare restrictions yet often face conflicts in care." Guiahi added that "Catholic hospitals should be more upfront about these restrictions to avoid conflicts." Kenneth White of the University of Virginia in Charlottesville echoed this sentiment, stating that "information about ownership, mission, vision, and values should be upfront in any hospital, regardless of affiliation, displayed both online and in the hospital."
The lack of transparency around religious affiliation and care restrictions can make it challenging for patients to make informed choices about their healthcare. In some cases, patients may only discover the restrictions after spending time and money on an appointment, only to be told that they cannot receive the desired or necessary treatment. This is particularly concerning for individuals facing pregnancy complications, as Catholic hospitals adhere to religious directives that prohibit certain reproductive health services, including contraception, sterilization, many infertility treatments, and abortion care, even when a woman's health or life is in danger.
The impact of these restrictions can be significant, especially for vulnerable or marginalized communities. As Guiahi noted, "like any restriction on healthcare, this often has the biggest impact on those who face systemic barriers to care, such as women with low incomes, people of color, LGBTQIA+ people, young people, and people in rural areas." Furthermore, state laws in many parts of the country shield hospitals from lawsuits for not performing procedures they object to on religious grounds, leaving patients with little recourse if they are harmed due to withheld care.
While Catholic hospitals have the right to their religious beliefs and practices, the lack of transparency around restrictions can compromise patient autonomy and informed consent. Patients should be able to easily access information about the potential limitations of their healthcare options to make informed decisions about their care.
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Frequently asked questions
You can use the Catholic Healthcare Association directory to see if your hospital is a member. Search online for comments and reviews, or call your hospital and ask them if they provide full-spectrum reproductive health care. You can also check if the hospital has a religious name, like St. Joseph.
Catholic hospitals are bound by rules and religious directives passed down by bishops that limit what kind of care you can access. This includes restricting access to abortion, even in cases of rape or incest, and other reproductive health services such as contraception, sterilization, and infertility treatments.
Catholic hospitals also prohibit procedures that are considered intrinsically immoral, including physician-assisted suicide and gender reassignment-related care. There is also disagreement about whether feeding tubes or ventilators can be removed for terminally ill patients, even if they have an advance directive requesting removal.
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