A physician in Colorado was fired in August when she joined a terminally ill cancer patient in a lawsuit to allow him to end his life-a right granted by the state's recently passed aid-in-dying law. Barbara Morris, a geriatrician with 40 years of experience, agreed to help Cornelius Mahoney, 64, end his life at home. However, her employer, Centura Health Corp., a Catholic-run health system, forbade it, citing religious doctrine that describes assisted suicide as "morally unacceptable," according to an August 30 report in Kaiser Health News. A few days after filing the lawsuit, Morris was fired for defying church doctrines that governed her employment.

The Centura case underscores the impact on health care services of the growing influence of Catholic hospitals and health care systems in the United States as a result of health care institution mergers. In some mergers between secular and religious-affiliated institutions, the secular institutions are required to follow church policies. In 2016, four of the 10 largest health systems in the nation were Catholic sponsored, according to a report by MergerWatch, Growth of Catholic Hospitals and Health Systems: 2016 Update of the Miscarriage of Medicine Report. And Catholic-owned or Catholic-affiliated hospitals included 548 acute care facilities, reflecting a 22% growth rate between 2001 and 2016. Currently, one out of every seven U.S. hospitals are Catholic owned or affiliated. In 20 states-most of them in the Northwest and Upper Midwest-from 20% to 40% or more of acute care beds (Alaska has the most with 49.2%) are in Catholic hospitals; and 46 communities in the nation are served only by a Catholic hospital.

End-of-life care is not the only area affected by the growth of Catholic health care systems; there are significant implications for reproductive health services as well. In 2018, the New York Times reported on women who were refused care by Catholic hospitals based on religious doctrine. Certain reproductive procedures, such as sterilization and abortions, were not performed. In the case of one woman, Jennafer Norris, who experienced life-threatening preeclampsia in three pregnancies (the last pregnancy the result of a failed IUD), the hospital refused to allow her physician to perform a tubal ligation immediately after an emergency cesarean section. Because the restrictions on clinical services are not advertised, patients-as in Norris's case-can be unaware of them until after they are admitted to the hospital and going elsewhere is no longer an option. In communities where the only hospital is Catholic, there may be no other options.-Frank Brodhead