Recently, the plenary assembly of the United States Conference of Catholic Bishops (USCCB) approved a revised version of the Ethical and Religious Directives (ERDs) for Catholic Health Care Services. The ERDs outline the USCCB’s directives to Catholic-owned and operated health care institutions including hospitals, geriatric practices, hospice organizations, and long-term care facilities. In this, the 7th edition (the first major revisions offered since 2018), the Bishops turned their attention to many issues that have received recent public attention–including VSED.
According to The Overreach Monitor, a Catholics for Choice watchdog group, ERDs impact the healthcare of a significant percentage of Americans:
The Ethical and Religious Directives for Catholic Health Care Services (ERDs)… apply to all types of institutions governed by Catholic healthcare, including “hospitals, clinics, outpatient facilities, urgent care centers, hospices, nursing homes, and parishes.” Because 1 in 6 acute care hospital beds in the U.S. are subject to Catholic healthcare restrictions, these religious restrictions impact millions of patients each year.
The Overreach Monitor notes that ERDs in Catholic healthcare services severely restrict or prohibit the following types of healthcare:
Abortion in all cases, including treatment for life-threatening ectopic pregnancies and timely care for pregnancy loss
Contraception to prevent pregnancy, including tubal ligation after giving birth
Emergency contraception for survivors of sexual assault
In Vitro Fertilization and other assisted reproductive technologies
Aid-in-dying care for people making end-of-life decisions
Gender-affirming care for queer and trans people, including hysterectomies, top surgery, and hormone replacement therapy
For the first time, the ERDs have also taken up the issue of VSED. The revised directives about end-of-life care define voluntarily stopping eating and drinking (VSED) as a form of suicide, which is never permissible, and direct Catholic healthcare entities to not only refuse to support a patient’s choice to utilize VSED but also to refuse to refer the patient to another clinic that might support their choices. Instead, the ERDs dictate that Catholic healthcare providers should advise patients that suffering while dying is a form of Christian redemption to be endured, albeit with the help of hospice and palliative care.
Here are additional details from the Overreach Monitor’s post, “Bishops Ban Gender-Affirming Care in Catholic Healthcare:”
Directives 60-65, which address care for the seriously ill and dying, have been edited substantially. Directive 60 now includes an explicit ban on Voluntarily Stopping Eating and Drinking (VSED), which is when a person at the end of their life decides to cease consuming food and fluids to aid the dying process. The new directives direct healthcare professionals to inform patients requesting VSED that “Catholic health services will not facilitate this course of action.” As in previous editions, the directives encourage providers to offer spiritual accompaniment for patients to “help them to appreciate the Christian understanding of redemptive suffering” (Directive 61). As of 2020, there were 139 Catholic-affiliated nonprofit nursing homes with 13,200 beds in the U.S.
…Particularly in rural areas, Catholic hospitals can be the only option: 52 regions in the U.S. rely solely on a Catholic hospital as the sole acute care facility in a 35-mile radius. Additionally, in many states, women of color are more likely to receive care at Catholic hospitals. In an emergency, transferring to a different facility is sometimes neither impossible nor financially feasible.
The seventh edition of the ERDs makes it even more challenging to seek care elsewhere. The newly edited Directive 27 explicitly states that “if a patient or a patient’s surrogate requests a medical intervention that is not in accord with Catholic teaching, health care professionals may not refer the patient to another professional for the purpose of obtaining that intervention.” In other words, the burden is on the patient to find a facility where they can expect to receive care.