Divergent practices among Catholic hospitals in provision of direct sterilization

The Ethical and Religious Directives for Catholic Health Catholic Care Services (ERDs) are designed to promote uniform practice of health care in accordance with human and Catholic values. The aim of this study was to determine whether the ERDs are being uniformly interpreted and applied. Directive 53 prohibits the provision of direct sterilization. Hospital data were reviewed to determine whether direct sterilizations on women are being performed within Catholic hospitals and their frequency. A significant diversity of practice regarding sterilization would indicate that the ERDs are not uniformly interpreted and applied by Catholic hospitals in the United States.

All Catholic hospitals in seven states-California, Illinois, Indiana, New Jersey, New York, Texas, and Washington-were studied to determine whether diversity of practice existed in the provision of direct female sterilization. Inpatient discharge data were requested from the respective departments of health for each state for three years (2007-2009). Data from 1,734 hospitals, secular and Catholic, within the states were procured and analyzed.

Of the hospitals from the seven states, 239 Catholic hospitals were identified of which 176 provided obstetric services. The patient records of these 176 hospitals were searched for those records containing the diagnostic code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system for sterilization for contraceptive management. Eighty-five or 48 percent of these hospitals provided a total of 20,073 direct sterilizations in violation of the ERDs. The entire results of the study are available on the website catholichospitals.org.

There is a significant diversity of practice in the provision of direct female sterilization within Catholic hospitals. Such diversity of practice indicates that there is no uniform interpretation or application of the ERDs by Catholic hospitals. Uniformity could be fostered if the ERDs mandated best practices for accountability and made use of the ICD-9-CM codes where possible to monitor actual practices. In the case of direct sterilizations reference to ICD-9-CM codes in the ERDs would minimize subjective criteria in the implementation of the ERDs.