Catholic hospital ban on tubal ligations challenged as discriminatory

Catholic hospital ban on tubal ligations challenged as discriminatory
The most effective and safest time to get a tubal ligation is during delivery, especially in the case of Ms. M because she's having a C-section and will be under anesthesia, the ACLU said. File Photo by Sasint/Pixabay

Sept. 27 (UPI) -- The American Civil Liberties Union of Michigan has filed complaints with state and federal agencies alleging a Catholic hospital's refusal to grant a woman an exemption from religious directives that ban tubal sterilizations is discriminatory and a denial of her right to "adequate and appropriate care."

The 38-year-old patient, who is identified publicly only as Ms. M, wants to undergo the procedure at the time of her scheduled Caesarean section in October at Ascension Providence Hospital in Southfield, Mich. Scarring from a previous C-section caused her bladder to fuse with her uterus, and her doctors have advised her that delivering any more children after this one would create substantial risks to her health, according to the ACLU.


However, the doctors also told her the hospital will revoke their admitting privileges if they perform the procedure. The physicians are required to comply with the Ethical and Religious Directives for Catholic Health Care Services, which are promulgated by the U.S. Conference of Catholic Bishops.

The directives prohibit a range of reproductive health services, including contraception and sterilization. Ascension Providence, which is part of Ascension, one of the largest Catholic healthcare systems in the United States, implemented the ban on Jan. 1.

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The ACLU alleges that the hospital is hypocritical to refuse to allow the tubal ligation because "it is our understanding that Ascension Providence is still allowing its physicians to perform vasectomies."

"If this is the case, then banning tubal ligations is an arbitrary, discriminatory policy," the complaints say.

Syeda Davidson, senior staff attorney for ACLU of Michigan, said the belief that the hospital permits vasectomies is based on anecdotal evidence, but even if it does not, the tubal ligation ban is still discriminatory because it has a disparate impact on women.

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The most effective and safest time to get a tubal ligation is during delivery, especially in Ms. M's case because she's having a C-section and will be under anesthesia, Davidson said. Vasectomies generally are not performed along with another surgery, she said.

Ascension executives did not respond to a request from UPI for comment, nor did the U.S. Conference of Catholic Bishops.

In late July, the ACLU emailed a letter to Ascension headquarters in St. Louis requesting an exception for Ms. M. The letter pointed out the religious directives say sterilization procedures are permitted "when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available."

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The ACLU also filed complaints in the summer asking the Michigan Department of Licensing and Regulatory Affairs Bureau of Community and Health Systems and the U.S. Department of Health and Human Services Office of Civil Rights to investigate the hospital policy on tubal ligations. The complaints ask the agencies to ensure that no one is subjected to "this medically dangerous and unnecessary policy" and that patients receive the highest standards of medical care regardless of their sex.

The hospital has not responded to the letter, Davidson said. The state has confirmed it is investigating, and the ACLU has confirmation from the OCR that the complaint was received.

Ms. M's doctors, who have safely delivered her two other children, have admitting privileges only at Ascension Providence and cannot provide her with care at another hospital, the complaints say.

"People should be permitted to practice their religion how they see fit, but you can't use your religion to hurt somebody, and that's what these policies are doing," Davidson said. "These are policies that are not based on any medical reasoning, and they're being used to deny people the medical care that they need, and that's wrong, and it's dangerous."

According to the complaints, Ms. M's options are not optimal. She could search for a new doctor and new hospital, which would be stressful at this point in her pregnancy; have the C-section at Ascension Providence and schedule the tubal ligation at another hospital after she heals; or not have the procedure and run the risk of a future pregnancy that could put her health in jeopardy.


Ms. M said in a news release that "this kind of medical decision must be made between a patient and their doctor, not as a result of a discriminatory and hypocritical religious mandate."

The ACLU has handled similar cases involving Catholic healthcare facilities. In 2015 and 2016, it filed complaints alleging Ascension and its Genesys Health Systems subsidiary discriminated against Jessica Mann, who planned to deliver a baby at Genesys Regional Medical Center in Grand Blanc, Mich.

Mann had a brain tumor that could be life-threatening when strained by pregnancy, and her doctors recommended that she have the tubal ligation at the same time as she delivered her baby to avoid the risk to her health of undergoing a second procedure after recovering from childbirth, the ACLU says.

Genesys refused to allow the tubal ligation, and Mann said she had to frantically search for a new doctor and a new hospital to get the care she needed.

The ACLU filed a federal lawsuit in 2013 on behalf of Tamesha Means, who went to Mercy Health Partners, a Catholic hospital in Muskegon, Mich., after her water broke when she was 18 weeks pregnant. The suit says there was virtually no way she could give birth to a healthy baby and that the safest course of action was to induce labor and end the pregnancy.


Instead, Means was sent home without being told that and without being treated for a serious bacterial infection. She returned to the hospital twice more the next day and was given medical care only after she started to deliver, the suit alleges.

Means, whose baby died within hours, sued the U.S. Conference of Catholic Bishops, claiming its directives cause pregnant women who are experiencing a miscarriage to be denied appropriate medical care.

The ACLU says the judge eventually dismissed the lawsuit partly because resolution of the case would involve reviewing religious doctrine.

The Women's Health Program of Community Catalyst, a national, non-profit consumer advocacy organization, says in a 2020 report that Catholic health systems are growing through mergers and acquisitions and exerting greater influence. In Michigan, 20 of its 105 hospitals, or 19 percent, were Catholic in 2020.

Catholic hospitals and health systems received nearly $48 billion in taxpayer money in 2020 in the form of Medicare and Medicaid reimbursements, while maintaining and seeking expansion of government permission to use religious doctrine to restrict care, according to the study. In 2011, that net patient revenue from the reimbursements had been $27 billion.

"This growth expands religious restrictions to more and more hospitals and, increasingly, to locations outside of the hospital where people seek care," the report says. "The consequences are especially concerning for maintaining access to comprehensive reproductive healthcare and LGBTQ-inclusive care, as well as legal end-of-life options in some states."


The report recommends ensuring greater transparency surrounding hospital and health system policies that prohibit the delivery of specific healthcare services; strengthening public oversight of proposed hospital mergers and acquisitions; and creating greater protection of individual patients' rights.

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