A coalition of advocacy groups is raising questions about whether the newly proposed affiliation of Swedish Health Services and Catholic-based Providence Health & Services will lead Swedish facilities to adopt Catholic policies that prohibit certain reproductive and end-of-life services for patients.

Robb Miller, executive director of Compassion & Choices of Washington, which supports patients in end-of-life choices including aid in dying under the state’s Death with Dignity law, said his group is working with Planned Parenthood, the American Civil Liberties Union, NARAL Pro-Choice Washington, and Legal Voice to “investigate and try to mitigate the impact” of the proposed Swedish-Providence alliance.

Lauren Simonds, executive director of NARAL Pro-Choice Washington, said her organization is concerned about the potential impact of the hospital alliance on thousands of women who receive their reproductive care at Swedish facilities. “We don’t believe it’s appropriate for one religion to impose its beliefs on people who seek care at their hospitals,” she told Crosscut. “The whole community goes there, they provide a public service, and women’s health care should fully include reproductive health care. It shouldn’t be treated separately.”

Last week, Seattle-based Swedish — which runs five hospitals and numerous clinics in Seattle, Edmonds, and Issaquah and employs 800 physicians — and Renton-based Providence — with multiple hospitals and clinics in King, Snohomish, Thurston, and Lewis counties — announced they had signed a memorandum of understanding to form a joint entity and combine operations to improve services and reduce costs. Both systems recently reported budget shortfalls and layoffs. The proposed affiliation likely will face state and federal regulatory review.

While Swedish announced that it will remain secular after the affiliation, the advocacy groups appear to have a foundation for their concerns. Swedish spokesman Ed Boyle said via e-mail that Swedish will stop providing elective abortions in its facilities once the affiliation with Providence is finalized. According to Boyle, Swedish would assure access to comprehensive women’s reproductive services through other organizations.

But Miller and Simonds asked what would happen if pregnant women in Swedish facilities faced an emergency condition, such as an ectopic pregnancy or miscarriage, requiring an abortion or related procedure to save their life or protect their health. Last year, Bishop Thomas Olmsted expelled St. Joseph’s Hospital in Phoenix from the Catholic Church and excommunicated a nun, Sister Margaret Mary McBride, because they had approved terminating the pregnancy of a woman suffering from life-threatening pulmonary hypertension.

“Will [Swedish] ship a woman to an emergency room elsewhere if she’s bleeding to death from an ectopic pregnancy gone bad?” Miller asked. Boyle said Swedish “will not provide elective abortions, but it will provide all emergency services required by women in an emergency situation.”

Boyle said Swedish facilities would continue to provide a full range of birth-control services, including tying the tubes of women who don’t want to or can’t safely bear any more children. He added, however, that those procedures “will be separately managed and governed.” While the details of that arrangement are still being worked out, he said, it likely will include a manager with responsibility for those services, reporting to a local Swedish board.

Another question is whether Swedish will change its approach to terminally ill patients considering ending their lives under the state’s Death with Dignity law. Catholic doctrine prohibits this practice.

Boyle said Swedish currently doesn’t directly participate in physician-assisted suicide. But its policy does allow Swedish physicians to decide individually whether to assist patients under the Death with Dignity law — though taking life-ending medications is not allowed in Swedish hospitals and Swedish pharmacies aren’t allowed to fill lethal prescriptions.

Miller said Swedish and its affiliated hospice and staff have supported patients who want to pursue the Death with Dignity option, typically referring them to Compassion & Choices for information and help. But he’s worried that Swedish will adopt Providence’s total prohibition on participating in aid in dying after the affiliation is finalized.

Providence Hospice of Seattle has a written policy barring its doctors, nurses, social workers, and other staff and volunteers from participating in any way in Death with Dignity activities. Providence hospice staff are not permitted to discuss with patients their options under the law or provide referrals for patients seeking information or assistance — except back to their attending physician. Any staffers who violate the policy are subject to sanctions.

“That’s unethical,” Miller said. “If a patient asks you to provide a legal procedure, you have an ethical duty to refer the patient. If Swedish Hospice is folded into the Providence Hospice, that would be a real step back, because Providence has the worst policies on Death with Dignity. They withhold information and undermine patient choice.”

A Providence spokeswoman referred all questions for this article to Swedish. Boyle said Swedish does not anticipate changes to its current Death with Dignity policies. But, he added, “we will be going through our policies to review them and make any adjustments in connection with the affiliation.”

There also are questions about whether Swedish would start following other religious and ethical directives issued by the U.S. Conference of Catholic Bishops. Those directives guide health care at the 27-hospital Providence system and at the more than 600 Catholic hospitals and hundreds of other Catholic health facilities across the country. The religious and ethical directives state that Catholic facilities do not have to comply with patient and family requests and patient advance directives that are “contrary to Catholic moral teaching.”

One directive requires Catholic facilities to provide tube feeding and hydration to patients in chronic, irreversible conditions such as persistent vegetative state. But many physicians, administrators, and ethicists, including those at Catholic facilities, say it’s wrong to require patients to receive this form of treatment, particularly if they had an advance directive saying they didn’t want it.

Boyle said Swedish "will not be subject to the [U.S. Conference of Bishops'] ethical and religious directives that apply to Catholic health care facilities." Asked specifically whether Swedish would follow Catholic policy on tube feeding and hydration, he said "we will be reviewing all policies and don't anticipate any significant changes from current practice."

The conflict between Catholic religious doctrine and secular health care delivery increasingly is playing out around the country as Catholic and non-Catholic hospital systems merge for business reasons. Advocacy groups in some communities have tried to block such mergers, citing concerns about the impact of Catholic doctrine on access to health care services.

Their fears are heightened by examples like Bishop Olmsted’s action in Phoenix and a similar case in Oregon. Last year, Bishop Robert F. Vasa expelled St. Charles Medical Center in Bend, a century-old hospital founded by nuns, from his diocese for refusing to stop performing tube-tying procedures.

Earlier this year, when Southwest Washington Medical Center in Vancouver merged with the Catholic-based PeaceHealth system, Southwest’s physicians and its hospice stopped helping terminally ill patients who want to pursue the Death with Dignity option. Miller said his group tried to mitigate the impact of the merger. But “doctors affiliated with Southwest who used to participate in Death with Dignity declined to do so after the merger,” he said.

The issue of how Catholic doctrine affects health care in Seattle previously arose in 2000, when Swedish took over a Providence's hospital in the Cherry Hill area. At that time, Compassion & Choices, Planned Parenthood, and NARAL raised concerns with Swedish and Providence leaders over how Catholic religious and ethical directives would affect reproductive and end-of-life care. Despite those discussions, Swedish decided to stop performing abortions at the hospital.