Cape Cod Healthcare’s policy of restricting abortion access, as reported in the Independent, is part of a much bigger national story. In the 37 states that still allow women reproductive choice, those rights may feel secure for now; but thousands of hospitals either ban abortion outright, discourage it, or limit it to complex cases involving grave medical risk. One study found that 57 percent of the nation’s teaching hospitals either ban abortion or drastically condition it.
In Massachusetts, Cape Cod Healthcare (CCHC) is the exception, but nationally it is all too typical. Hospital executives don’t like controversy. Some clinicians — typically radiologists and nurses but not OB-GYNs — are squeamish about elective abortions. Even when the institution doesn’t prohibit abortions, new residents soon learn that the hospital’s norms are to discourage them or limit them to cases of dire medical need.
Catholic hospitals, about one-sixth of all hospitals in the U.S., ban abortions entirely. Some formerly Catholic hospitals, such as those affiliated with Catholic Healthcare West (now called Dignity Health), were made to sign no-abortion agreements even after they ceased being Catholic. These are known by OB-GYNs as “zombie Catholic hospitals.”
In hospitals that prohibit or discourage abortions, the typical practice is to refer requests for abortions to an ethics committee that determines whether the abortion is “medically necessary,” and to refer elective abortions to unaffiliated outpatient clinics. Planned Parenthood wins wide praise from OB-GYNs. The problem is that there is no Planned Parenthood clinic on Cape Cod and CCHC owns almost all of the clinics.
The Independent asked Patrick Kane, senior vice president for communications at CCHC, if abortion decisions at Cape Cod Hospital are made by an ethics committee. He didn’t respond, so we don’t know the scope or nature of the hospital’s limitations.
The prohibition of abortions by hospitals denies women both choice and their health, and it helps anti-abortion fundamentalists. According to the Guttmacher Institute, 19 states require that abortions be performed in a hospital if the fetus is beyond a certain gestational age, but many of these states are the ones where hospitals often refuse to permit abortions at all.
Last Friday, President Biden issued an executive order intended to protect women’s privacy and to defend and expand access to medication abortions and emergency contraception. Biden also has the power under Medicare, Medicaid, the Affordable Care Act, and federal subsidy of medical education to insist that hospitals receiving federal funds provide the full range of normal reproductive care services.
Here on the Cape, CCHC is listed as an “affiliate” of Boston’s Beth Israel Hospital, now Beth Israel Leahy Health, which provides the full range of reproductive health services, including abortions. I contacted Beth Israel’s media relations chief to ask about the contradiction and got back a statement that compounded the contradictions:
“Beth Israel Lahey Health affirms our commitment to providing equitable access to the full range of reproductive services [and] provides abortion access under Massachusetts law. As part of our affiliation with Cape Cod Healthcare (CCHC), which aims to expand and provide seamless, coordinated access to care for patients, families and visitors on Cape Cod, CCHC maintains its independence in many areas including, for example, the services it provides, as a locally governed healthcare institution.”
Note that, on the one hand, Beth Israel vouches for CCHC’s “seamless, coordinated access to care” but, on the other, defends its right to limit that care arbitrarily.
Robert Kuttner is co-founder and co-editor of The American Prospect and a professor at Brandeis University’s Heller School.