The Catholic Thing
Sterilization at Catholic Hospitals Print E-mail
By Sandra Hapenney   
Thursday, 23 February 2012

The HHS mandate for contraceptive and abortifacient coverage in all health insurance plans has caused a flurry of activity among Catholics and others concerned about religious liberty. But current practices in some Catholic hospitals – notably contraceptive sterilizations – could put the political efforts of concerned individuals and groups in no little jeopardy. 

Contraceptive sterilizations, more technically labeled direct sterilizations in the Ethical and Religious Directives (ERD) of the U.S. Conference of Catholic Bishops, are elective medical procedures that violate human dignity and Catholic moral teaching. 

Rumors of these procedures at Catholic hospitals prompted an anonymous investigation of public health data from Texas in 2008. In July of that year, Our Sunday Visitor carried a four-page report on direct sterilizations at Texas Catholic hospitals and on the national problem of violations of the ERD. 

The 2008 data also showed that there were some Catholic hospitals that provided no sterilizations. It also led one bishop, Alvaro Corrada of Tyler, immediately to address the issue at two offending hospitals and to bring an end to the problem in his diocese. The hospitals involved did not dispute the basic accuracy of the research data.

As a doctoral candidate with a background in public health and theology, I decided to quantify the level of compliance with the ERD on a national scale and to analyze the legal and political consequences violations might have on conscience-clause protections.  

My study involved obtaining hospital inpatient data from the departments of health of seven states dispersed geographically (CA, IL, IN, NJ, NY, TX, WA), abstracting records for Catholic hospitals from over 47 million patient records, and comparing sterilization practices at the hospitals from 2007 to 2009. 

For the institutions I studied, 48 percent of the 176 Catholic hospitals with obstetric services performed direct sterilizations in clear violation of the ERD. The findings were independently reviewed by the Computer Science Department of Baylor University. Interactive data tables and the dissertation itself are viewable here.

Clinically, the medical code used in the research (ICD-9-CM diagnostic code V25.2) explicitly calls for sterilization for the purposes of contraceptive management. The procedure treats no existing pathology (a future pregnancy is not a present pathology).

In Catholic moral teaching and in the ERD, a V25.2 sterilization is therefore always a direct sterilization and, as such, is forbidden. This prohibition includes those V25.2 sterilizations, popularly called “medically indicated,” done to prevent a future pregnancy that may risk the life of the mother and/or child.

Procedures permitted by the ERD for an existing pathology that result indirectly in sterilization would be coded with diagnostic and procedure codes related to the particular pathology rather than use V25.2 and its associated procedures. However, the offending hospitals in the study were reporting diagnostic and procedural codes for direct sterilizations. At the same time, the hospitals profess to have acted in accord with the ERD. 

How are we to understand this claim of fidelity to the ERD in the face of the unambiguous clinical data showing direct sterilizations? The Holy See has for forty years repeatedly sought to put an end to aberrant moral theories, such as proportionalism, which falsely label as “indirect sterilizations” procedures the Church has always considered to be direct sterilizations. 

Dr. John Haas of the National Catholic Bioethics Center and others have argued that despite the efforts of the Vatican many hospital ethics boards continue to provide direct sterilizations by labeling them indirect. Ann Carey’s article, “Shocking lack of understanding,” discusses the widespread “confusion” at the hospitals. Some moralists may label the V25.2 sterilizations indirect, but certainly many in authority at the hospitals have enough Catholic training to know these are direct.

Their knowledge explains their careful use of terms in defending themselves against accusations. Across the country, the same stock phrase is employed “we follow the ERD” without any description of the procedures involved or an unequivocal statement that “we don’t do tubal ligations.”

A major difficulty in achieving a uniform application of the ERD is, unfortunately, that the directives make no reference to clinical diagnostic and procedure codes and do not mandate transparent reporting or oversight of a hospital’s actual policies and practices. Nor does the ERD mandate reporting violations within the hospital settings. 

The result is that subjective judgments of hospital personnel and ethics committees can readily prevail over the objective clinical situation and the teaching of the Church. Best practices for oversight, such as used in the protection of minors, could be included in future editions of the ERD. Important elements of best practices would include an independent review board, mandatory reporting of violations, objective clinical criteria for defining violations, and authoritative presentations to doctors and staff regarding the requirements of the norms. 

Current practice is perilous not only to those sterilized in Catholic hospitals, but poses juridical and legal risks to all Catholic personnel and facilities. Individual Catholics or hospitals objecting to these procedures could find themselves isolated and more easily compelled by the courts or legislation to provide direct sterilizations. 

The lack of agreement among the Catholic hospitals also undermines any cohesive defense of religious liberty in this matter by the bishops and the hospitals. Uniform application of the ERD at every Catholic hospital is therefore crucial to the protection of the conscience rights of every Catholic medical professional and of all Catholic health care facilities.

Dr. Sandra Hapenney, a new contributor, has a master’s degree in theology from St. Mary’s University, a master’s in Public Health specializing in biostatistics and epidemiology from the University of Hawaii, and a doctorate in church-state Studies from Baylor University. She teaches theology at a Catholic high school and epidemiology at Baylor University. She may be reached via email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it
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Comments (5)Add Comment
written by manfred, February 23, 2012
In the words of Capt. Renault to Rick in Casablanca: "I am shocked, shocked.." to learn that tubal ligations have been occurring in Catholic hospitals in the U.S. Thank you for a splendid article Dr. Hapenny: you have torn the facade from the evil which has existed for decades. Now, of course, the great question is how will it ever be repaired?
written by Matt, February 23, 2012
Driving down the highway the other day I saw a huge sign for something called Dignity Health. This is the new name for Catholic Health Care West…which recently decided to ditch the Catholic label. Sad.

With respect to: Across the country, the same stock phrase is employed “we follow the ERD” without any description of the procedures involved or an unequivocal statement that “we don’t do tubal ligations.”… seems like they have transferred this type of duplicity into their rather Orwellian new name.

Thanks for this informative presentation
written by Margaret, February 27, 2012
How interesting. I had no idea. My local Catholic hospital belonged to Catholic Healthcare West until 2002 (?) when they separated off into a smaller, new group, Daughters of Charity Health System. I distinctly remember being informed at a pre-natal visit several years ago that I could *not* have my tubes tied while in the hospital for delivery. I wasn't asking, mind you, they just felt the need to inform me... I assumed all Catholic hospitals were on board with this.
written by Nonny , February 27, 2012
We are far away from the days when faithful sisters ran Catholic hospitals, and that is a major part of the problem. Also, since most of the laity follow worldly ways, not Church teaching on these matters, that means that the staff of these hospitals are not on board with Church teaching. Therefore it is not surprising that they violate it.

I was personally told by a Catholic woman that when she was on the table having her third child, the doctor at the Catholic (supposedly) hospital asked her if she wanted her tubes tied, since this was her third child. AND I know from a personal, unsuccessful search for a faithful Catholic gynecologist, that where I am, EVERY SINGLE GYNECOLOGIST AFFILIATED WITH THE CLOSEST 2 CATHOLIC HOSPITALS IS A BIRTH CONTROL PRESCRIBER. It's outrageous, and now we are paying the price. It's time to clean house or something. It would be better for us not to run hospitals than to violate Church teaching and scandalize those who are faithful (few though they may be!), not to mention that human beings lives are taken by hormonal contraceptives and related drugs.
written by Lucy, March 17, 2012
Snappy, on target explanation for why most of the laity follow worldly ways:

"The Church hasn't been teaching the teaching."

Even the Church can inadvertently be subsumed by the world.

Praying for re-focus and a re-set (which it seems we're already starting to see as a result of the unmistakably menacing mandates).

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