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Stephanie SladeJuly 26, 2018

The website FiveThirtyEight has identified a worrying trend sweeping the nation: Too many hospitals are affiliated with the Catholic Church. As a result, people who want procedures such as abortions, vasectomies, tubal ligations and gender reassignment/confirmation surgeries are forced to travel, sometimes tens of miles, to have them done. This, apparently, is a scandal.

The first piece in its series is troublingly partial and borderline dishonest, a surprising fit for the outlet founded by celebrity statistician Nate Silver, for whom I have always had respect. By casually defining the services at issue as “standard medical procedures,” it begs the question of whether hospitals should provide them. And by ignoring the existence of millennia-old teachings by the church, let alone their merits, it treats one side of a contentious debate—and the constitutionally dubious side, at that—as if it were uncontroversially, self-evidently true.

(If you’re curious about the other side, I wrote a feature for America on this very subject more than a year ago.)

For a website with a quantitative bent, FiveThirtyEightis surprisingly willing in this case to use statistics to obscure the truth.

For a website with a quantitative bent, FiveThirtyEightis surprisingly willing in this case to use statistics to obscure the truth. It notes, for instance, that in 45 communities in the United States, the sole hospital is a Catholic institution. The denominator in that equation—45 of how many total? 100? 10,000?—is not disclosed. The nearest the article comes to offering that kind of important context is to cite a MergerWatch report claiming that one in six hospital beds in the country is Catholic-owned or affiliated. And of those roughly 17 percent of beds, how many have non-Catholic options nearby? The authors, Anna Maria Barry-Jester and Amelia Thomson-DeVeaux, either did not bother to find out or decided not to tell us.

There is a qualitative sleight-of-hand at play here as well. The piece creates the impression that men at Catholic hospitals have insidiously pushed women out of decision-making positions. Back when nuns were primarily in charge, Barry-Jester and Thomson-DeVeaux write, “what was permitted and forbidden wasn’t always clear,” and so “doctors sometimes had more opportunities to seek exceptions for patients or offer care through loopholes.” Now that the bishops and their “stricter interpretation of religious doctrine” have taken control, marginalized patients don’t stand a chance.

Is that true? It surely is the case that the church has institutionalized its oversight and clarified its teachings over the last 300 years. Yet when the authors want someone in a position of authority to defend the policies they find so problematic, they quote a press release from “the president and CEO of the Catholic Health Association,” who emphatically calls the procedures “an assault on the dignity of human life.” Tellingly, they fail to mention who the president and CEO of the Catholic Health Association is: not a man but Carol Keehan, a sister of the Daughters of Charity.

The most offensive thing about FiveThirtyEight’s argument is how thoroughly it strips female patients of all human agency.

In any case, the question that really matters is whether religiously affiliated hospitals can be forced against their will to perform abortions and the like—and the answer to that question is no. Despite ongoing challenges from the American Civil Liberties Union and others, the courts have been unanimous on this point, siding with the bishops each and every time. As Judge Ernest Goldsmith put it, “Religious-based hospitals have an enshrined place in American history and its communities, and the religious beliefs reflected in their operation are not to be interfered with.”

The arguments against interference are not just constitutional. MergerWatch has been at pains to alert the public that remote communities are increasingly likely to have only a Catholic hospital nearby. This is in part because “rural hospitals, particularly independent ones, are struggling financially and closing down by the dozens,” the article says. So the Catholic Church is keeping hospitals afloat in places where no other medical institutions have managed to survive—and this is an argument for targeting them with legal action?


The Catholic Health Association’s Sister Keehan was not having it when I interviewed her for my story last year. “When some of the people who are making these statements have done as much for this country as Catholic health care has, then I think they might achieve some standing,” she said.

For me, the most offensive thing about FiveThirtyEight’s argument is how thoroughly it strips female patients of all human agency. “As many as 40 percent of women don’t come back for a postpartum visit with their OB-GYN, so if the hospital where they deliver their baby won’t offer contraceptive procedures or devices, they may not have a second opportunity to easily get long-term contraception,” Barry-Jester and Thomson-DeVeaux aver, before quoting a retired obstetrician saying that in such cases, “We’ve lost them, and then they can’t get that care.” One could be forgiven for thinking these were references to wildlife in a catch-sterilize-and-release program, not adult women in the most advanced country on Earth. Last I checked, people are not bound forever to the hospital where they give birth, and needing to make a second doctor’s appointment is not an obstacle so insurmountable as to warrant jettisoning the First Amendment.

That the A.C.L.U. threw away its commitment to religious freedom in the name of abortion rights is bad enough. A journalistic enterprise as ostensibly sane and data-driven as FiveThirtyEightshould think twice before following the same path.

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Dolores Pap
3 years 4 months ago

Do Catholic hospitals receive tax payer money? If so, then the ACLU is correct in going after them if they refuse certain treatments, esp in an emergency.. Hospitals should be required to help women who need it- or be disqualified from receiving public money .

Maggie Flynn
3 years 4 months ago

So what you are actually saying is that Catholic hospitals shouldn't be able to take any low income patients in need of financial assistance to access medical care--and that when a Catholic hospital is the only hospital in a rural or economically depressed area that hasn't chose profit over healthcare that that hospital should be forced to close and the people will in some bizarre twisted way be "better off"? SMH

J Jones
3 years 4 months ago

What she is saying that when sn organization or institution applies for, receives and utilizes the tax money of ALL .American citizens, it is accountable to American citizens.

Maggie Flynn
3 years 4 months ago

So she is, in fact, saying that Catholic hospitals must stop treating low income patients who utilize public assistance. You can put as much icing and sprinkles on a meatloaf as you like--but underneath it's not going to magically turn into cake.

Kimmy Tran
3 years 4 months ago

I don't quite understand how you're managing to ignore what both comments say and try to respond to them at the same time.
She is saying that they cannot receive taxpayer funding and at the same time, deny life-saving care to those who need it on a personal, non-medical basis (in this case, on the basis of religious beliefs).

Just because they are the "only hospital in a rural area" (which by the way, means that they have a monopoly on care in the area) does NOT give them the right to refuse to perform emergency or life-saving medical procedures, because if someone is refused care, then it's the same as not having a hospital at all!

If they are unwilling to treat women who need it, then let them be disqualified from public funding. That money could go to a hospital that is actually willing, kind, and capable enough to treat those who need it, not just the "chosen ones".

Kudos to Dolores and J, who both know what's up.

William deHaas
3 years 4 months ago

Friend is the SVP of Mission of a catholic health system with many rural hospitals. The issue is more complex than this criticism tries to summarize. Here is an excellent article from Mother Jones that articulates many of the issues that 538 tried to highlight:

https://www.motherjones.com/politics/2013/10/catholic-hospitals-bishops-contraception-abortion-health-care/ (this is more than 4 years ago)

Catholic rural hospitals and the local bishop implement Catholic ERDs but, at the same time, if the hospital is the only county facility - it must also meet federal guidelines. So, catholic owners have to institute silos in which MDs, guidelines, etc. meet Catholic ERDs and also federal rules. If catholic owners fail to heed federal guidelines (e.g. contraceptives) then they will lose federal dollars - no rural hospital can afford that.

Reality - most catholics do not follow nor support the *cultic* episcopal norms around birth control, family planning, etc. That alone makes some rural Catholic hospitals problematic - they deny federally approved treatments to the population based upon very narrow partisan and religious beliefs. How would catholics feel if the shoe was on the other foot and a non catholic hospital owner in their county refused certain treatments based upon their religious beliefs? A broader look at this issue also raises questions about VII's Religious Liberty - Dignitatis Humanae....which calls catholics to accept that there are religious differences and to respect those differences. This post and author criticizes Silver's 538 opinion piece but her criticism ignores the church's own viewpoint on respecting differences between faiths, beliefs, etc.

Stuart Meisenzahl
3 years 4 months ago

BUT SEE "NFIB VS SIBELIUS" , Supreme Court June 28, 2012 holding that penalizing states who refused to expand their Medicaid Programs as required by Obama Care was "unconstitutionally coercive" . Certainly not directly on point but an analogous situation. In fact the Feds provided these grants to Catholic Hospitals with full knowledge of their existing policies on refusing to provide abortion services. Having created dependence through expansion etc, the withdrawal of such grants to compel a change in those preexisting policies would clearly be " coercive". And in the context of the First Amendment it might well be "unconstitutionally coercive".

Trish Peyton
3 years 4 months ago

So, in essence, you are saying that if Catholic hospitals, in order to receive federal funding, were required to provide abortions needed to save women's lives, then Catholic hospitals would choose to forego those federal funds and would choose to forego the provision of health care to the poor that these funds would have enabled? Am I clear in understanding that you believe it would be the government's fault that these hospitals would treatment to the poor suffering from illness and injury, because the government wouldn't allow Catholic hospitals to deny any abortions needed to save women's lives? If a pregnant woman dies, the baby dies, anyway. I don't understand such brutality and harshness in the name of our Church. Is that actually what our Church teaches? Thank goodness the government shows more mercy than the Church and provides Catholic hospitals funds for at least the partial care of the poor, anyway.

Stuart Meisenzahl
3 years 4 months ago

I believe the discussion of this topic takes place on two levels: The legal level respecting whether acceptance of government funding requires acceptance of government regulation and the moral level respecting the reasonableness of Church's moral precepts respecting abortion. The two levels do intersect in a clash under the First Amendment respecting the intrusiveness of a regulation upon the practice of religious principles ....... and this clash will be a settled by the Supreme Court., but if, and only if the Federal Government takes action to force its regulatory will upon the hospitals ....or more likely the ACLU initiates another suit on behalf of an individual who claims to have been injured by the hospital policy.
Should the Church affiliated hospitals react to an adverse Vourt ruling like the Church affiliated adoption agencies have reacted under similar circumstances, then I think you will find hospitals closing or massive government funding required to buy out the operations if it wishes to maintain the viability of those operations. Should the government refuse to take over those operations then it would indeed be the government's fault.for any adverse results that followed. Again I note that the Government has willingly provided grants with full knowledge of existing morals based Operating guidelines and without conditioning the receipt of such grants in any way affecting those guidelines.

Phillip Stone
3 years 4 months ago

Not to make too fine a point of it, but in 50 years of medical practice I have never encountered this mythological beast, the pregnancy which will kill the mother if the child is not killed first.

On the other hand, I have attended some pregnancies which were labelled as such, the baby must go to save the mother, and they all went successfully to the end and produced a live mother and a live baby.
Interesting enough, it was a ward in a tertiary teaching hospital in an Australian capital city which kept collecting pregnant women from the other services after those services had performed heroic feats of medicine on the woman concerned. One day, in a row there was someone who had almost died from a massive pulmonary embolism removed surgically in time to save her life, a woman who had been rescued from chronic renal failure by a cadaver kidney transplant, another who had damaged heart valves replaced when she was at the point of death, another who had been brought back from the brink of death from diabetes, another who had survived breast cancer and so on. I asked each why she went and got pregnant despite their life-saving specialist teams issuing dire warnings against it - the answer was simple - they had only agreed to the drastic medical procedures so as to be able to live a life more close to normal, and for them that meant having a child and a family life previously impossible while they were ill, close to death with no future to look forward to.

Somehow faith, hope and trust come to mind.

Lindsey Gibbons
3 years 4 months ago

Look I'm anti-abortion so don't accuse me of being otherwise, but have you never heard of an ectopic pregnancy? That is very much a pregnancy that could threaten the life of the mother. It can also adversely effect fertility.

Elle Salmon
3 years 4 months ago

Indeed, ectopic pregnancy rates are on the rise worldwide and in the U.S. had risen to 19.7 per 1000 pregnancies, remaining one of the leading causes of maternal mortality, even though advances in treatment have been made and fewer patients experience a rupture. Room for compromise might be found between the moral commitments of Catholic hospitals and the needs of patients who have time to schedule procedures in advance, or the obligations that come with using public tax dollars. However, life-threatening emergency services should not be subject to this type of conflict, including ectopic pregnancy or other situations where a pregnant woman's life is endangered.

Peggy Ehling
3 years 4 months ago

“In 45 communities in the United States, the sole hospital is a Catholic institution. The denominator in that equation—45 of how many total? 100? 10,000?—is not disclosed. The nearest the article comes to offering that kind of important context is to cite a MergerWatch report claiming that one in six hospital beds in the country is Catholic-owned or affiliated. And of those roughly 17 percent of beds, how many have non-Catholic options nearby? The authors, Anna Maria Barry-Jester and Amelia Thomson-DeVeaux, either did not bother to find out or decided not to tell us.“
Neither did you.
While I can think of many things the media gets wrong about Catholic hospitals and Catholic schools and Catholic beliefs, it seems like if you are going to call them out and correct them then you ought to provide the informaton you find wanting in secular media reports.
So, 45 communities out of how many?
Catholic hospitals do an incredible amount of good work in the US and they deserve credit for it. But the non-Catholic part of the US also deserves to have their health care needs met. And all of us, as you point out, could assess the current situation better with more accurate information. Please provide it.

William deHaas
3 years 4 months ago

Note - you support your arguments by showing that 538 did not provide documented evidence. Guess what - you repeated that same mistake.
Here is what your criticisms leave out:
a) https://www.guttmacher.org/gpr/2016/07/abortion-lives-women-struggling-financially-why-insurance-coverage-matters
b) fact - low income women do not have the *full human agency* that you underline in your criticisms - which only reveals the weakness of your arguments
c) studies and the courts have supported the reality that many state attempts to restrict abortion, birth control, etc. have increased abortions - e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880271/
d) studies have proven that economic factors are the key to why women have unwanted pregnancies - to effectively fight that we need to address the inequalities in US society (vs. how Catholic hospitals have been unfairly criticized by 538)
e) rural hospitals are often Catholic owned - that is true and it impacts women/families.
f) you completely ignore and skip over the fact that family planning efforts directly result in a decrease in abortions; better pre and post natal care; better family situations. You leave all of those significant factors out in your criticism.
Finally, you might want to interview Sr. Keehan again on family and women's healthcare; family planning; contraception; and the current state by state assault on the Catholic Social Justice belief that healthcare is a human right - not a luxury.

Stuart Meisenzahl
3 years 4 months ago

You reference The Journal of Public Health in your "number c)" above. That article merely states that restrictions in various states on abortion providers has also resulted some of those providers not offering contraception services. It certainly does not argue or present any facts demonstrating as a result of imposing abortion restrictions that either the number of abortions actually increased or that such restrictions were the cause of any increase. Your oblique reference to "Courts and studies " supporting your thesis is unsupported by any reference.
I certainly agree that abortion users cite economic considerations as the foremost reason for seeking that procedure but in the absence of a study that controls for such a variable (as well as the variable of contraceptive availability) in the context of new abortion restrictions, no one can reasonably assert a "cause and effect relationship " between imposing abortion restrictions and any subsequent increase in such procedures

Tim O'Leary
3 years 4 months ago

Stephanie - great article. I too like the fivethirtyeight site for its quantitative data and I completely agree that they wrote a very biased article in this case. There are 3,242 counties in the US and 5,534 hospitals (1,825 rural), or 1-2 per county. So, 45 is a small number. About 20% of hospitals are Catholic. They are growing because they are better managed and do a better job. Let the atheists build their own hospitals in rural areas if they want to do their dirty work there.

It is very important to keep these sites honest, so well done. https://www.aha.org/statistics/fast-facts-us-hospitals

3 years 4 months ago

Stephanie, thanks for your comments and support of Catholic health care. I too was surprised by the lack of objectivity in the 538 report.

Another thing they don't mention is that if Catholic health care did not step in, these 45 rural communities would have no hospital at all. I was part of decisions in which a failing community hospital was absorbed by a Catholic system and became the sole provider. True, we don't provide ALL services, but no hospital does. Every hospital has its specialities and also service lines it doesn't provide. The fact that we receive federal reimbusement is irrelevant. All hospitals receive federal funds, and none of them provide every service.

Another important fact is that not only is our CEO a woman, but virtually all of our hospitals were founded by women and largely in order to serve women and children. 59% of our hospitals have OB departments, more than the national average.

We we have no apology for what we do for women.

Maggie Flynn
3 years 4 months ago

Perfectly said.

Ellen B
3 years 4 months ago

If you are going to be in the BUSINESS of health care, the health of the patient should be foremost. By "casually" including elective surgeries in her argument Ms Slade writes an article that could be accused of the same "troubling" & "partially dishonest" writing as she says is true of the FiveThirtyEight series. A trip of "tens of miles" is important in the event of a medical emergency. A mother needing an abortion in order to save her own life is a medical emergency. A mother having a miscarriage & unable to receive medical treatment at the hospital she has gone to is a medical emergency. There is a reason that maternal deaths are higher in the US than in any other industrialized country (by a HUGE degree). And if Catholic hospitals are going to accept FEDERAL dollars, they need to provide life saving services in the BEST INTERESTS OF THE PATIENT & if they are not, they need to get out of the BUSINESS.

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