A Catholic health worker opposed contraception. Her Catholic clinic fired her

A young medical professional from Portland, Oregon, was fired this year for opposing certain medical procedures based on his Catholic faith.

However, she was fired not from a secular hospital, but from a Catholic health system, which claims to follow Catholic teaching on bioethical issues.

"I certainly didn't think there was necessarily a need to hold Catholic institutions accountable for being pro-life and Catholic, but I hope to spread awareness," Megan Kreft, a medical assistant, told CNA.

"Not only is it unfortunate that the sanctity of human life is undermined in our Catholic health systems: the fact that it is promoted and tolerated is unacceptable and frankly scandalous."

Kreft told CNA she thought medicine would align well with her Catholic faith, although as a student she anticipated some challenges as a pro-life person working in the health sector.

Kreft attended Oregon Health and Science University in Portland. As expected, in medical school she encountered procedures such as contraception, sterilization, transgender services, and had to apologize for all of them.

She was able to work with the Title IX office to obtain religious housing while in school, but ultimately her experience in medical school led her to exclude work in primary care or the health of women. women.

"Those areas of medicine need providers who are more committed to defending life than any other," he said.

It was a difficult decision, but he says he got the feeling that medical professionals working in those fields tend to accept more questionable procedures like abortion or assisted suicide.

“We are called in the field of medicine to truly take care of the mind, body and spirit,” he stressed, adding that as a patient he struggled to find life-affirming medical care.

However, Kreft wanted to be open to whatever God was calling her, and she came across a position as a medical assistant at Providence Medical Group, her local Catholic hospital in Sherwood, Oregon. The clinic is part of the larger Providence-St. Joseph Health system, a Catholic system with clinics across the country.

“I was hoping that at least my desire to practice medicine consistent with my faith and conscience would at least be tolerated, at the very least,” Kreft said.

The clinic offered her the job. As part of the hiring process, she was asked to sign a document agreeing to comply with the institution's Catholic identity and mission and the U.S. Bishops' Ethical and Religious Guidelines for Catholic Health Services, which provide authoritative Catholic guidance. on bioethical problems.

In Kreft, it seemed like a win for everyone. Not only would a Catholic approach to health care be tolerated in his new workplace; it seemed that, on paper at least, it would be enforced, not just for her but for all employees. He happily signed the directives and accepted the position.

Before Kreft started working, however, she says one of the clinic's administrators contacted her to ask her what medical procedures she would be willing to offer as a personal assistant.

On the list provided - in addition to many benign procedures such as stitches or toenail removal - were procedures such as vasectomy, intrauterine device insertion, and emergency contraception.

Kreft was quite surprised to see those procedures on the list, because they all go against ERDs. But the clinic offered them to patients quite openly, he said.

It was disheartening, he says, but he vowed to stick to his conscience.

In the first few weeks of the job, Kreft said he asked a doctor to refer a patient for an abortion. He also found that the clinic encouraged providers to prescribe hormonal contraception.

Kreft contacted the clinic's administration to tell them she had no intention of participating or referring to those services.

"I didn't think I had to be explicit with this, because again, the organization said these weren't services they provided," Kreft pointed out, "but I wanted to be at the forefront and find a way forward."

He also contacted the National Catholic Bioethics Center for advice. Kreft said she spent many hours on the phone with Dr. Joe Zalot, a personnel ethics expert at NCBC, studying strategies on how to address the ethical dilemmas she was facing.

Most people are unaware of the nuances of Catholic bioethics, and NCBC exists to help healthcare professionals and patients with these questions, Zalot told CNA.

Zalot said NCBC often receives calls from health workers who are pressured to act in ways that violate their conscience. Most of the time they are Catholic clinicians in a secular system.

But every now and then, he said, they get calls from Catholics working in Catholic health systems, like Megan, who are under similar pressure.

"We see Catholic health systems doing things they shouldn't do, and some are worse than others," he commented.

Kreft spoke to her clinic director and chief mission integration officer of her concerns and was told that the organization "does not control suppliers" and that the patient-provider relationship is private and sacred.

Kreft found the clinic's response unsatisfactory.

“If you are a system that doesn't appreciate [ERDs], see them as bureaucracy, and you won't make the effort to verify that they are integrated or that staff and suppliers understand them, it's almost better not to [sign them]. Let's be consistent here, I was getting very mixed messages, ”Kreft said.

Despite the clinic's insistence that it "does not provide police services," Kreft believed his health decisions were under scrutiny.

Kreft says her clinic director at one point told her that the clinic's patient satisfaction scores could drop if she didn't prescribe contraception. Eventually, the clinic forbade Kreft from seeing any female patient of childbearing age, explicitly because of her beliefs about contraception.

One of the last patients Kreft saw was a young woman he had seen previously for a problem unrelated to family planning or women's health. But at the end of the visit, he asked Kreft for emergency contraception.

Kreft tried to listen with compassion, but told the patient she could not prescribe or refer for emergency contraception, citing Providence's policies on the matter.

However, when Kreft left the room, he realized that another healthcare professional had intervened and was prescribing the patient's emergency contraceptive.

A few weeks later, the regional medical director called Kreft for a meeting and told Kreft that his actions had traumatized the patient and that Kreft had "harmed the patient" and thus broke the Hippocratic Oath.

“These are big and meaningful claims to make about a healthcare professional. And here I was operating for the love and care of this woman, taking care of her from a medical and spiritual point of view, ”Kreft said.

"The patient was undergoing trauma, but it was from the situation she was in."

Later, Kreft approached the clinic and asked her if they would allow her to take a Natural Family Planning course for her continuing education requirement, and they declined because it “wasn't relevant” to her job.

ERDs state that Catholic health organizations must provide NFP training as an alternative to hormonal contraception. Kreft said she was unaware that anyone at the clinic was trained in NFP.

Eventually, the clinic's leadership and human resources informed Kreft that she needed to sign a performance expectation document, stating that if a patient requests a service that she herself does not provide, Kreft would be obligated to refer the patient to another. Providence health worker.

This would imply that Kreft was referring to services that she, in her medical judgment, considered to be detrimental to the patient, such as tubal ligation and abortions.

Kreft says she wrote to the leadership of the health care system, reminding them of their Catholic identity and asking why there was such a disconnect between ERD and hospital practices. He says he has never received an answer to his questions regarding ERDs.

In October 2019, she was given 90 days notice of withdrawal because she would not sign the form.

Through mediation facilitated by the Thomas More Society, a Catholic law firm, Kreft agreed not to sue Providence and was no longer employed in early 2020.

Her goal in the resolution, she says, was to be able to tell her story freely - something a litigation may not have allowed her to do - and be a source of support for other medical professionals who have similar objections.

Kreft also filed a complaint with the Civil Rights Office at the Department of Health and Human Services, which works with employers to come up with a corrective action plan to remedy civil rights violations and may even get funding. federal if the violations continue.

He says there are currently no major updates on that complaint; the ball is currently in the HHS court.

Providence Medical Group did not respond to CNA's request for comment.

Kreft says that by practicing pro-life health care, she wanted to be "a little light" in her clinic, but this "was not at all tolerated or allowed in the organization."

“I was expecting [opposition] in a secular hospital where my training was, but the fact that it is happening within Providence is scandalous. And it confuses patients and their loved ones ”.

He recommended any health care professional facing an ethical dilemma to contact NCBC, as they can help translate and apply Church teachings to real-life situations.

Zalot recommended that all Catholic health care workers familiarize themselves with the protections of conscience in place at the hospital or clinic where they work and seek legal representation if necessary.

Zalot said NCBC is aware of at least one physician within the Providence Health System who approves assisted suicides.

In another recent example, Zalot said he received a call from a health worker from another Catholic health care system who was seeing gender reassignment surgery going on in their hospitals.

If workers or patients observe Catholic hospitals doing things contrary to ERDs, they should contact their diocese, Zalot advised. NCBC can, at the invitation of a local bishop, conduct an "audit" of a hospital's catholicity and make recommendations to the bishop, he said.

Kreft, in some ways, is still faltering after being fired for six months in her first medical job.

He is trying to defend others who might find themselves in a similar situation to his own, and hopes to encourage Catholic hospitals to choose to reform and provide "the vital health care they were founded to provide."

“There are probably other health workers, even within Providence, who have experienced similar situations. But I imagine that Providence is not the only Catholic health system in the country that struggles with this ”.