How Catholic hospitals may restrict healthcare access for rural Americans

Catholic hospitals' right to refuse healthcare services based on religious or moral grounds can threaten access to high-quality, comprehensive reproductive care for Americans living in rural communities with limited hospital options, according to a report from FiveThirtyEight.

"In a growing number of communities around the country, especially in rural areas, patients and physicians have access to just one [Catholic] hospital," the report's authors wrote. "Catholic hospitals are bound by a range of restrictions on care that are determined by religious authorities, with very little input from medical staff. Increasingly, where a patient lives can determine whether Catholic doctrine and how the local bishop interprets that doctrine, will decide what kind of care she can get."

Here are seven things to know:

1. While many independent rural hospitals are closing amid greater financial pressures, Catholic health systems have managed to weather the tough financial climate, in part due to their nonprofit status, the authors noted. Estimates suggest one in six hospital beds are Catholic-owned or even affiliated, along with most of the nation's nonprofit heath systems, according to

2. In 2011, about 29 communities nationwide had one Catholic hospital to use for their care, and in 2016, that number grew to 45 communities according Merger Watch.

3. Ms. Thomson-DeVeaux and Ms. Barry-Jester said it is difficult for patients to know what services are offered due to each facilities' interpretation of Catholic doctrine, which is decided by local bishops. While decisions are made on a case-by-case basis, treatments including abortion, birth control, vasectomies, tubal ligations, some types of end-of-life care, emergency contraception and procedures related to gender transition are can be forbidden at these hospitals, according to the report.

4. Several physicians working for Catholic institutions told FiveThirtyEight about instances they could not provide patients with the best treatment possible due to their employers' religious restrictions. In one case, , such as an instance where a bishop banned tubal ligations after a C-section, which could have killed a patient.

5. Some states have laws protecting individuals' or institutions' right to refuse services based on ethical and moral beliefs.

6. Physician organizations, including the American College of Obstetricians and Gynecologists, express concern over the growth in Catholic health systems compromising availability and quality of reproductive care.

7. The California Medical Association, representing 43,000 physicians, attempted to intervene in a California lawsuit over a denied tubal ligation. CMA's president-elect said patients and physicians, not hospital administrators, need to make the primary decisions when it comes to health outcomes. The U.S. Conference of Catholic Bishops declined to comment on the lawsuit. However, in a statement earlier this year, the president and CEO of the Catholic Health Association said, "The conscience of Catholic healthcare does not allow us to participate in certain procedures we feel are an assault on the dignity of human life, such as abortion and euthanasia. That same conscience compels us to love and respect others who feel differently," according to the report.

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