August 30, 2020; Yakima Herald
For years, economic and regulatory pressures have been driving independent hospitals to consolidate. The expected merger of two nonprofit health systems in the Seattle region, Virginia Mason Health System and CHI Franciscan, is part of this trend. Yet, as we know, in a merger process, important patient rights can be compromised.
In the state of Washington, patients who know that they have less than six months to live can, after consultation, “request lethal doses of medication from medical and osteopathic physicians.” The process is rigorous, requiring two separate doctors and full documentation to the state, but it does legally allow an individual to decide to avoid a painful, lingering death.
When the merger is concluded, the combined system will become part of one of the Nation’s largest health care systems, CommonSpirit Health. Virginia Mason allows its staff to prescribe end-of-life medications if requested, but CHI Franciscan and CommonSpirit are Catholic organizations and prohibit both the discussion and implementation of such means. When the merger is complete, CHI Franciscan policy will prevail.
As a Catholic-affiliated organization, CommonSpirit follows directives issued by Church leadership. Expectations were set by the US Conference of Bishops in 2018, which was disturbed by the way many hospitals were ignoring or working around Church law on contraception, abortion, LGBTQ-services, and end-of-life care.
“Whatever comes under the control of the Catholic institution—whether by acquisition, governance, or management—must be operated in full accord with the moral teaching of the Catholic Church,” the directives state.
These directives were meant to be forceful. “The rule of thumb is a Catholic hospital in partnership with a non-Catholic hospital cannot formally cooperate with doing evil,” said Bishop Robert McManus, who chaired the subcommittee that drafted the new directives.
Patients facing the most difficult of healthcare choices will be forced to find new professionals, if they can, to help them make tough decisions. Speaking to the Yakima Herald, Judy Kinney, executive director of End of Life Washington, describes the impact of the merger on men and women with few month remaining to live:
Imagine working with your primary physician for years and you have on the books that if I contract a terminal illness and have six months or less to live, I want to access Death with Dignity. You get to this point and all your doctor can say is, “Here’s a brochure. Good luck.”
How hard does it have to be for someone to access a law that’s in place? It’s completely unreasonable.
Dr. Gary Kaplan, Virginia Mason’s Chairman and CEO, during a State of Reform “Leadership Series” virtual conversation, recognized something important was being lost and that organizational needs were more important than those of his patients.
Is it perfect? No, in many respects. People who know me know my own personal values. We believe that we have enough in common and that this, as we’ve looked at all the potential partnerships…
We believe this gives the best opportunity for Virginia Mason and for our new joint operating company to really thrive in the future. And so, we’ve had to make some decisions around that, and we’ll make more as we go forward.
Kaplan hopes, despite the directive of the Conference of Bishops, that his hospitals “will continue to provide the full range of women’s reproductive services, family planning services, and contraception…will continue to provide the full range of LGBTQ services including transgender services… and the full range of palliative services which includes palliative sedation and other end-of-life approaches as well.”
The organizational imperative for survival can become too important. When two organizations begin to merge, how critically should they examine their beliefs and their values? How easily should they cast them aside as a cost of continuing to do business?
Catholic-affiliated organizations are clear about what they stand for and what they cannot sanction. Would that every organization followed their lead before they compromised, agreeing to impose a heavy burden on their patients and give up on their former principles to survive. Perhaps struggling on would have been worth it, given the services for which it was fighting.—Martin Levine