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In 2017, UCSF Health announced a formal affiliation with several Dignity Health hospitals in the Bay Area, and we understand from information presented by UCSF at the University of California Regents Health Services Committee (the “Committee”) meeting on December 11, 2018, that plans are underway to expand this partnership beyond the Bay Area, perhaps throughout the University of California system.
UCSF has publicized this partnership as a strategic alliance of two distinguished and long-serving Bay Area providers recognized for clinical excellence and missions to provide affordable care to all. However, Dignity Health, along with other Catholic health care entities, imposes significant religious restrictions on the care it permits in its facilities. These restrictions would be at irreconcilable odds with the University of California’s professed values of evidence-based, inclusive, and comprehensive patient-centered care, as well as its legal obligations as a public institution.
Catholic Health Care Restrictions and their Impact on Patients and Providers
All Catholic health care, including Dignity Health’s Catholic hospitals, must adhere to policy proscriptions issued by the United States Conference of Catholic Bishops (the “Conference of Catholic Bishops”), some of which are spelled out in the Ethical and Religious Directives for Catholic Health Care Services (the “ERDs”).
As a result, Catholic health care entities are explicitly prohibited from providing a range of end-of-life health services, significantly limit a patient’s ability to refuse or discontinue unwanted medical treatments, and restrict family members from making decisions for those who can no longer make decisions for themselves. In fact, the Conference of Catholic Bishops mandates that religion take precedence over patient decision-making autonomy by expressly stating in the ERDs that “the free and informed health care decision of the person . . . is to be followed so long as it does not contradict Catholic principles.” Thus, the ultimate authority over Catholic health care is religious doctrine, not standard medical care.
UCSF Would be Subject to this Same Doctrine
Dignity Health currently comprises Catholic hospitals that adhere to the ERDs and affiliated non-Catholic hospitals that adhere to the Statement of Common Values. While historically, non-Catholic hospitals have had lesser restrictions, in 2018, the Conference of Catholic Bishops issued an update to the ERDs that changes the landscape of Catholic health care systems and their affiliates.
The new ERDs state that hospitals affiliated with a Catholic institution through acquisition, governance or management “must be operated in full accord with the moral teaching of the Catholic Church, including these Directives.” The new ERDs similarly address partnerships with secular hospitals:
“Before affiliating with a health care entity that permits immoral procedures, a Catholic institution must ensure that neither its administrators nor its employees will manage, carry out, assist in carrying out, make its facilities available for, make referrals for, or benefit from the revenue generated by immoral procedures.”
Such “immoral procedures” include, but are not limited to, refusal of unwanted or non-beneficial medical treatment, such as medically assisted nutrition and hydration, and removal from life sustaining treatments, such as ventilators. The ERDs go so far as to dictate that when a patient’s pain is uncontrollable and their suffering cannot be alleviated, a doctor must help their patients “appreciate the Christian understanding of redemptive suffering,” rather than “deprive them of consciousness” or honoring their request for respite in the form of continuous deep sedation (a/k/a palliative or terminal sedation) or medical aid in dying.
If this partnership is allowed to move forward, patients at Dignity Health-affiliated UCSF hospitals would not only be denied access to comprehensive end-of-life care, including medical aid in dying, but they would be refused accurate information about all available options and referrals to outside providers willing to provide this information and medical services.
Furthermore, the University of California, a public entity, seeks to partner with a private entity that explicitly restricts patient care on the basis of its religious doctrine. The University of California is subject to the federal and California Constitutions, which prohibit government entities from, among other things, advancing religion. UCSF Health cannot comply with these legal obligations if it enters into an arrangement that will subject its patients to Dignity Health’s religious restrictions on medical care.