St. Elizabeth's Hospital board of directors decided in June that the sterilization procedure would no longer be provided at the hospital in order to more fully comply with the Catholic Health Care Ethics Guide.

During an audit of policies and procedures, it was discovered that doctors were not complying with the hospital's existing tubal-ligation policy, said board chair Jerome Strasser. That policy called for an ethical reflection and application in light of the church's teaching. It replaced an earlier policy in which an ethics committee reviewed requests for the procedure.

Catholic teaching as expressed in the Catholic Health Care Ethics Guide is that "Direct sterilization, whether permanent or temporary, for a man or a woman, must not be used for contraception."

"This is consistent with the church's whole teaching on sexuality, marriage and birth control. Our sexuality has that double dimension: it unites the couple in love, while also being open to life," said Saskatoon Bishop Albert LeGatt.

The Catholic Health Care Ethics Guide was a joint work of the Canadian bishops and the Catholic Health Association of Canada, reflecting Catholic theology and moral teaching as it is practically applied in Catholic health care settings, he said.

Under certain circumstances a tubal-ligation procedure could be tolerated in principle in a Catholic setting, as an indirectly intended consequence associated with other serious health factors if such procedures cannot be delayed, or require transfer to another health care facility that would constitute a threat to the life or health of the patient, he said. "And if it was a case of life and death at that moment, there is no question that a woman's life and health at that moment would be the primary consideration."

News that women in the Humboldt area would now have to travel to Saskatoon for the procedure prompted local protests, including a petition started by local doctors.

"The decision opens up a lot of ethical questions about the rights of the individual and about how health care is provided in a publicly funded system," Levick said.

Catholic hospitals in Saskatchewan operate as affiliates of larger health regions, in a collaborative relationship which recognizes the need for a faith-based facility to operate by its values and principles, said Monica Beavis, CEO and president of the Saskatchewan Catholic Health Organization. The corporation oversees the operation of a number of Catholic health care facilities across the province that were turned over to the Catholic bishops by various religious orders.

It is possible to manage procedures around the provision of tubal ligations in such a way that they can be offered without violating Catholic ethics, as is accomplished in some Catholic hospitals in Canada, said Beavis. "But the St. Elizabeth's hospital board was faced with a situation where its policy was found to be not working. There was a lack of compliance," she said.

"It's a matter of collaborating with the region and with the physicians to provide the care, while respecting the principles of the Catholic hospital," she said.

"A Catholic health care institution exercises a community right, generated by the Constitution, based on freedom of religion and conscience – it cannot be forced to do something contrary to its teachings or its conscience. The same principle would hold for any other faith-based health care institution," said Bishop LeGatt.

"The Saskatchewan Catholic Health Corporation certainly acknowledges the concerns of the community and the feedback we've received related to the tubal-ligation decision," added Beavis. "We are collaborating with various stakeholders to look at a plan or a process to ensure that we are in fact serving the community, and yet are doing that within our Catholic Christian values."

Darlene Eberle, chair of the Saskatoon Health Region Authority, said that the region values its affiliate relationships with faith-based facilities. "We accept and appreciate St. Elizabeth's faith-based approach."

Further discussions about the tubal ligation ban will be held this week, facilitated by the Saskatoon Regional Medical Association. Discussions will include representatives from the St. Elizabeth's board of governors, the Saskatchewan Catholic Health Care Corporation, the Humboldt physician group and Saskatoon Health Region medical leadership, as well as a Catholic ethicist.

Strasser welcomed the discussions. "We will have to come to some consensus," he said. "This is not a fight. There are no winners in this thing. The community at large is losing."

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