Part Six - Forming New Partnerships with Health Care Organizations and Providers
CASE STUDY
CASE #1: EMPLOYED PHYSICIANS AND CONTRACEPTION
Saint Vincent's Hospital is negotiating with an obstetrician and an urologist to join its medical group, with offices in St. Vincent's Physicians' Building. Both will be identified as employees of St. Vincent's. They understand that in accordance with the ERDs they will not be permitted to perform tubal ligations or vasectomies in the medical center or in their offices. Both have raised questions regarding their continued ability to provide the services that they consider to be medically appropriate. Both want to be able to continue performing sterilizations. At present, both think that they can find another venue apart from St. Vincent's in which to do this and ask if this would be permitted. Both doctors have also raised the question regarding how to obtain provider numbers to use in billing for their services, if they must find an outside venue.
In addition, the obstetrician has a question regarding her being able to continue prescribing contraceptives and to insert IUDs in her office. Although she does not agree with the moral position of the Catholic Church, she wants to be part of the medical group and understands that St. Vincent's is a Catholic organization. She also believes that it is important to enter any agreement with the hospital with integrity. However, she also thinks that it is an imposition on her patients to tell them to go elsewhere for either contraceptive prescriptions or for an IUD. To find a compromise, she has suggested that she and the hospital find a formula in which she technically leases back her office from St. Vincent's during those times in which
she performs these tasks. (Courtesy of Catholic Health Initiatives).
CASE QUESTIONS
1. What ethical issues do you see here?
View answer
- Physicians employed by a Catholic hospital performing sterilizations at a location not associated with Saint Vincent's.
- A physician employed by a Catholic hospital writing prescriptions for contraceptives and IUDs in his/her office.
- The obstetrician leasing back her office from the hospital in order to prescribe what is contrary to Church teaching. Illicit cooperation.
- The possibility of scandal. How will patients know what is "Catholic time" versus "non-Catholic time" and how? The Catholic institution could be perceived as condoning contraception.
2. Which Directive(s) apply to the case?
View answer
- 52, 53, 67, 68, 69, 70, 71, 72
3. How might the Directive(s) help address the case?
View answer
- Directive 53 prohibits direct sterilizations. Performing sterilizations, even in another location, as an employed physician of St. Vincent's would be morally problematic. However, if these physicians arranged on their own for a "limited private practice" during which time they were not employees of St. Vincent's and performed the tubal ligations elsewhere under a separate license and with their own billing, this would not involve St. Vincent's in morally illicit cooperation. For further information about limited private practice, see John Haas et al., "Model Clinical Practice Ethics Guidelines for Affiliated Health Care Professionals with Respect to Prescription of Contraceptives," in Edward Furton, ed., Catholic Health Care Ethics: A Manual for Practitioners (Philadelphia: National Catholic Bioethics Center, 2nd edition, 2009): 99-101.
- Directives 52 and 70 speak to the issue of prescribing contraceptive measures. Provision of contraception for non-medical purposes is forbidden in Catholic organizations.
- Directive 69 points to the need to apply the principle of cooperation. This would be relevant to the obstetrician's suggestion that she lease back her office space for those times when she does prescribe. Whether or not such an arrangement would be morally permissible would require an application of the principle of cooperation. The key components of the principle can be found in the Glossary. If St. Vincent's were to agree to this proposal, this would almost certainly be an instance of immediate material cooperation (providing something essential to the wrongdoing of another) and, possibly, formal or at least implicit formal cooperation. By working out this arrangement, the hospital would seem to be approving prescribing contraceptives by one of its employed physicians on premises owned by the hospital.
- Implementing the obstetrician's proposal could very likely be a source of true scandal as defined in footnote 45 of the Ethical and Religious Directives. Because prescribing contraception would occur in the St. Vincent's Physicians' Building by an employed physician of the hospital, the hospital could be perceived as condoning contraception which could lead others to believe that there is nothing morally problematic with contraception. From the perspective of patients, it would be virtually impossible to distinguish between when the office space was "St. Vincent's office space" and when it was the "OB/GYN's private office space," contributing to confusion and possible scandal.