Dr. Doug Diehl's response to my guest opinion of last week left me with the impression that nothing would really change regarding medical decision-making or doctor-patient relationships in an Ashland Community Hospital-Dignity Health partnership.
Dr. Diehl, representing the ACH board, in his April 16 guest opinion states, "By joining Dignity Health, we would remain a secular facility and would not be subject to the Ethical and Religious Directives for Catholic Health Care Services, nor would we ever be influenced by the decisions of the Catholic Church.
Yet It is my understanding that the Archbishop of San Francisco and "the Sisters" ultimately still will set policy based upon Catholic Health Care precepts under certain circumstances, even in secular hospitals. On the Dignity Health website in a letter written Feb. 17, the archbishop of San Francisco (in whose diocese resides Dignity Health corporate offices) clearly states, "non-Catholic hospitals would continue to follow their ethical protocol, which does not allow them to perform direct abortions and certain other procedures."
This is confusing to me. Who are we to believe, Dr. Diehl and the ACH board, or Archbishop Niederauer? And who has ultimate authority in such decision-making? Can abortions be performed in circumstances other than those endangering the life of the mother?
In my career here in the Rogue Valley, multiple physicians have, under rare and unique circumstances, performed abortions at ACH. While it is true that most are performed in outpatient clinics, I will present three scenarios in which an inpatient abortion may be requested. I am typically involved with any two of these scenarios in any given year caring for women in this region, and at some time a woman from Ashland will find herself in this, or a similarly horrific and tragic position. The question becomes, will health care providers and the community of Ashland be able, as they currently are, to embrace such women and say yes, we will care for you and provide compassionate and loving care, or will they have to say we are sorry, we cannot care for you because Dignity Health, our partner, has rules that say you must go to Medford or Portland?
1) A 12-year Ashland Middle School girl is abused and impregnated by a male relative. She is unable to even tolerate a typical gynecologic exam. She needs an abortion under a general anesthetic in a hospital as opposed to the usual abortion under local anesthetic in a clinic.
2) A woman is found in the second trimester to have a fetus with a 100 percent lethal condition, such as anencephaly (the fetus has no brain) or renal agenesis (the fetus has no kidneys or lungs), and she asks for an induction of labor termination.
3) A woman is found in the second trimester to have a fetus with profound anomalies, including brain anomalies, but the condition is not 100 percent lethal. But it is certain the child will never walk, feed itself or communicate. The family asks for an induction of labor termination.
These are difficult issues to talk about. They are, however, very real issues in our community. Terminations of pregnancy in such situations could occur currently at ACH. Could they in the future?
They certainly are well within the scope of safe medical practice of multiple providers on staff at ACH.
Another issue to consider: Hospitals are partnering with physicians all across the country, and in fact owning physician practices. If in the future it was felt by ACH-Dignity Health administration that it was good for the hospital and the community to hire and employ two well-qualified obstetricians, and in the hiring process the obstetricians said "I desire to practice the full spectrum of obstetrics in my outpatient clinic, including first trimester abortion and artificial insemination, is that allowed?" what would the response be from administration?
So again, I need clarification here. Who do I believe, the ACH Board of Directors or the archbishop of San Francisco?
The question now is, is there a greater good in partnering with Dignity Health in terms of keeping the hospital open, preserving jobs, etc., fully recognizing that to do so there will be rare circumstances in which a religion-based organization from outside of Ashland will intrude into our families' medical decision-making processes? Or should we reconsider whom we partner with?
This decision ultimately could affect our ability, here in Ashland, to provide the full range of women's health care services and reproductive choices for our daughters, sisters, partners and friends.
I think public hearings involving ACH and Dignity Health officials, the Ashland City Council and Ashland citizens are in order. I invite representatives from Dignity Health, including the Most Rev. George Niederauer, Archbishop of San Francisco, to come to Ashland to give us clarity on such matters.
Bryan Sohl, M.D., is a physician at Rogue Valley Medical Center who specializes in complicated pregnancies. He lives in Ashland.