View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by St Andrews Research Repository WOMEN’S HEALTH CARE IN AMERICAN CATHOLIC HOSPITALS: A PROPOSAL FOR NAVIGATING ETHICAL CONFLICTS IN ACCESSING REPRODUCTIVE HEALTH CARE Taylor Jacob O’Grady A Thesis Submitted for the Degree of PhD at the University of St Andrews 2018 Full metadata for this item is available in St Andrews Research Repository at: http://research-repository.st-andrews.ac.uk/ Please use this identifier to cite or link to this item: http://hdl.handle.net/10023/16588 This item is protected by original copyright Women's Health Care in American Catholic Hospitals: a Proposal for Navigating Ethical Conflicts in Accessing Reproductive Health Care Taylor Jacob O'Grady This thesis is submitted in partial fulfilment for the degree of Doctor of Philosophy (PhD) at the University of St Andrews September 2017 i DECLARATIONS Candidate's declaration I, Taylor Jacob O'Grady, do hereby certify that this thesis, submitted for the degree of PhD, which is approximately 72,000 words in length, has been written by me, and that it is the record of work carried out by me, or principally by myself in collaboration with others as acknowledged, and that it has not been submitted in any previous application for any degree. I was admitted as a research student at the University of St Andrews in September 2014. I received funding from an organisation or institution and have acknowledged the funder(s) in the full text of my thesis. Date Signature of candidate Supervisor's declaration I hereby certify that the candidate has fulfilled the conditions of the Resolution and Regulations appropriate for the degree of PhD in the University of St Andrews and that the candidate is qualified to submit this thesis in application for that degree. Date Signature of supervisor Permission for publication In submitting this thesis to the University of St Andrews we understand that we are giving permission for it to be made available for use in accordance with the regulations of the University Library for the time being in force, subject to any copyright vested in the work not being affected thereby. We also understand, unless exempt by an award of an embargo as requested below, that the title and the abstract will be published, and that a copy of the work may be made and supplied to any bona fide library or research worker, that this thesis will be electronically accessible for personal or research use and that the library has the right to migrate this thesis into new electronic forms as required to ensure continued access to the thesis. I, Taylor Jacob O'Grady, confirm that my thesis does not contain any third-party material that requires copyright clearance. ii The following is an agreed request by candidate and supervisor regarding the publication of this thesis: Printed copy No embargo on print copy. Electronic copy No embargo on electronic copy. Date Signature of candidate Date Signature of supervisor Underpinning Research Data or Digital Outputs Candidate's declaration I, Taylor Jacob O'Grady, hereby certify that no requirements to deposit original research data or digital outputs apply to this thesis and that, where appropriate, secondary data used have been referenced in the full text of my thesis. Date Signature of candidate iii ABSTRACT The Catholic Church is one of the largest providers of medical care in the US, with 1 in 6 acute-care beds residing in a Catholic hospital. One third of these hospitals are in rural or underserved areas in the US, and advocacy for the vulnerable is a central platform of the Catholic Healthcare Association. Despite this, the Church has been under attack for allegedly putting women at risk of injury or death due to the care restrictions concerning reproductive health stipulated in the Ethical and Religious Directives (ERDs). Additionally, scholars are questioning the distinctiveness of the Catholic healthcare mission in practice, pointing to the increased homogenization of Catholic and non-Catholic hospitals. For these reasons, it is necessary to assess if and how women are being harmed in Catholic hospitals and, if there is harm being done, if there is a way to prevent these harms while preserving the Catholic Social Tradition in medicine. In carrying out this assessment, I read the current literature closely to explore both the origins and the practical consequences of these ethical conflicts. Subsequently, I use Chris Durante’s “pragmatic perspectivism” to formulate a proposal that considers both Catholic medical ethics and secular medical ethics on the same plane. The proposal suggests the adoption of an alternative and complementary lens for Catholic health care. Using this framework would allow the Church to pursue its health care mission in a fuller sense, unencumbered by the inertia of the medical industry towards homogenization due to legal and economic pressures. It also provides the potential for Catholics to more easily receive Catholic care in all hospitals, not just those under Catholic sponsorship. Importantly, it would also prevent any American woman from being practically forced to receive Catholic care, circumventing many of the ethical conflicts present in the current system. iv ACKNOWLEDGEMENTS First, I would like to thank both the US-UK Fulbright Commission and the University of St. Andrews, who worked in concert to provide me with the funding that made this research possible. My time as a Fulbright Scholar over the last three years have been some of the most influential in my life, both in terms of my development as an academic and as a human being. I vow to carry the lessons I learned as a Fulbright scholar with me in my future career as an academic and as a physician. Next, I would like to thank my dedicated supervisor, John Perry. John, who was both incredibly patient and challenging, provided the best supervision I could have asked for over my time at St. Andrews. His guidance allowed me to achieve what I thought was unachievable as a newcomer to the field and I am eternally grateful. Stephen Holmes and Gavin Hopps also provided me with great support towards the end of my thesis, stepping in to fill John’s shoes when necessary. Brian Brock at the University of Aberdeen served as an additional reader before submission, for which I am also grateful. I would also like to thank Charles Camosy from Fordham University, who helped foster my interest in Christian medical ethics during my undergraduate studies and continues to volunteer his mentorship and support to this day. Finally, I want to thank the family and friends that have supported me in my endeavors, even when they took me abroad for three years. To my parents and my brother, thank you for supporting me through this process. Your continued emotional support helped sustain me through the hardest times of my academic journey. To my loving husband, Brendan, your undying support and faith has not only made this process feasible, but fulfilling. I fully recognize the sacrifices you had to make for me to be able v to pursue my dreams, suffering through the challenges of a three-year long-distance relationship leading up to our wedding. I love you more than you could ever imagine, and I dedicate this work to you. vi TABLE OF CONTENTS Declarations ........................................................................................................................ i Abstract ........................................................................................................................... iii Acknowledgements .......................................................................................................... iv Chapter 1: Introduction ..................................................................................................... 1 Background ................................................................................................................... 1 Research Question and Aims ........................................................................................ 3 Audience and Stance ..................................................................................................... 6 Methodology ................................................................................................................. 7 Scope ........................................................................................................................... 10 Review of the Literature .............................................................................................. 11 Chapter 2: The Place of Catholic Hospitals in US Health Care ...................................... 29 Origins ......................................................................................................................... 30 What Makes a Catholic Hospital Distinct? ................................................................. 32 Mission .................................................................................................................... 33 Identity .................................................................................................................... 34 Integrity ................................................................................................................... 35 The Ideal Catholic Healthcare Institution ................................................................... 42 Legal Issues in Catholic Health Care .......................................................................... 50 The Crux of the Issue