UPMC Mercy revisits tenets of its identity

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When employees of UPMC Mercy gathered for a daylong seminar on the Catholic identity of their hospital Friday, the first stories they heard weren't about high profile issues such as abortion and euthanasia.

Phyllis Grasser, the vice president for mission effectiveness and spiritual care, read a letter from a prisoner expressing gratitude that the hospital staff had treated him with respect. A nurse in the audience said that being a Catholic hospital means that, "If you're a prisoner, I take care of you the same way I would take care of you if you were the bishop."

In 2007 Mercy Hospital, both the first and last Catholic hospital in the region, merged with secular UPMC under an agreement to maintain its Catholic ethics and ethos. It was the first such arrangement in the nation between a Catholic hospital and a secular health system, and has become a model for several others, said the Rev. Lawrence DiNardo, chief canon lawyer of the Diocese of Pittsburgh and diocesan liaison to Mercy.

"It has been working exceptionally well," Father DiNardo said.

One written agreement made in the merger was that Mercy would continue to provide free care to the poor. The percentage of free care has increased under UPMC, Father DiNardo said.

Late in the day two medical ethicists spoke on difficult issues, particularly regarding end-of-life care. But much of the workshop provided biblical, theological and historical context for understanding Catholic social teaching and the mission of UPMC Mercy.

Father DiNardo outlined how a Catholic hospital fits into the church structure and the extent and limits of a bishop's authority over it. But he emphasized that its Catholic identity isn't rooted in rules but in the call of Jesus.

"The patient we have in front of us isn't just a patient who has come here for some procedure, but a child of God entrusted to our hands to be cared for" physically and spiritually, he said. "In the day of final judgment we will be asked to render an account of how well we have done and how we have used our lives to minister to others."

Patients should be able to observe that the care they receive is rooted in faith, but the goal isn't to seek converts, he said.

"When you talk about Catholic identity, you're not talking about making everybody Catholic. You're talking about making sure that every person who comes through the door, no matter what their religious background, realizes that they are being touched by someone who has committed themselves to faith."

Ms. Grasser said the chaplains ensure that patients receive spiritual care from any tradition they choose, and have a directory of local religious leaders they can call. She cited an example in which Buddhist traditions for caring for the body of a recently deceased person were carefully followed, and the family was given a space in the chapel to burn incense.

The religious ideals of Catholic hospitals have taken on a high profile recently because of an impending rule from the federal Department of Health and Human Services that would require religious agencies to provide free contraceptives to employees as part of any health insurance. Catholic bishops are protesting, calling it a violation of their mission, ethics and religious liberty.

But Friday's session was planned before that rule became public, Ms. Grasser said. It is the third such session Mercy has offered and was attended by about 40 of 2,700 employees. A goal is to provide lay leaders for the religious mission, because so few sisters are left.

Six Sisters of Mercy remain on the hospital staff, though some retired sisters still volunteer. Among the latter is Sister Joan Laboon, 84, who spoke about the sisters' call to serve the poor, the sick and the uneducated.

She recounted a running exchange with hospital president Will Cook about prisoners. First, she said, she noticed that they were forced to wait in a hallway outside the hospital coffee shop while the guards went inside.

"I saw that the guards had coffee and the prisoners were forlorn," she said. "I sent a message to Will Cook and said the prisoners are sitting there and they don't have anything ... He answered my e-mail and said 'You can give them coffee every day and tell the girl not to charge them.' "

Then, due to a problem, she said, the waiting prisoners were moved to an alley. She shot another message to the president, who had them placed in a quiet hallway near the auditorium.

"Now, when I pass, I say to the guards, 'Did you get them coffee?' " she said.

Sister Joan ministers to the families of patients who stay in apartments that the hospital set up for those who come from far away. She is part of the No One Dies Alone team, taking the night shift to pray with or hold the hand of those in their final hours.

Those, the presenters said, are the kind of actions that grow from Mercy's list of core values: reverence for each person, community, justice, commitment to those who are poor, stewardship, courage and integrity. During the session and in interviews, many participants said they wanted to work in a Catholic hospital because of such values.

"It's so nice we have the freedom ... where if a patient wants to pray with us, we can do that," one nurse told the group, saying she moved to Mercy from another hospital so she could express her faith.

Diane Calderone, a respiratory therapist, said it didn't matter to her that Mercy was a Catholic hospital when she was first hired 12 years ago.

"Now that I'm here, I can't see working anyplace else," she said. "I am of the Catholic faith and I work a lot in critical care and see a lot of these things practiced, as far as dignity and the spirituality."

Patrick Holleran, a patient care technician at Mercy, said he isn't Catholic and disagrees with some aspects of Catholic ethical teaching, but he respects the hospital's commitment.

"I'm glad there's a hospital that stands up for pro-life values," he said.

Valerie Satkoske, a medical ethicist for Mercy, Children's Hospital of Pittsburgh of UPMC and Wheeling Hospital, delved into some of the key ethical issues that set Catholic hospitals apart from many secular ones.

She urged the employees to read "Ethical and Religious Directives for Catholic Health Services," a succinct guide from the U.S. Conference of Catholic Bishops.

She was a graduate student when she realized that some common fertility treatments violated church teaching.

"I had not been taught that, and we did not talk about that in church," she said. "Here, where you work in a Catholic facility, you have an obligation to know the teaching of the church on these things."

But the directives need to be interpreted, and even two bishops might interpret a given situation differently, she said. There is more leeway built into the directives than stereotypes about Catholic medical care imply, she said.

"This isn't an answer book. It gives us the tools to have this conversation," she said.

Deliberately taking the life of another human, whether a fetus or a dying adult, is forbidden, she said. But the church balances the burdens and benefits of treatment, and won't force a patient to accept treatment against his or her will, she said.

While it would be wrong to give a suffering patient an overdose of pain killer to cause death, she said, if a dying person can only be kept comfortable by doses that have the potential to hasten death, that is acceptable. She showed a chart with situations in which withdrawing a feeding tube would be either acceptable, debatable or unacceptable.

It might be acceptable where the patient was dying and the tube was causing pain; it might be debatable for an advanced Alzheimer's patient who refused to eat and who repeatedly pulled the tube out, she said.

The case of Terri Schiavo, who was in a vegetative state but wasn't dying, caused the Catholic bishops to alter their directive. They added a presumption in favor of feeding someone who isn't dying and who can't express his or her own desires, she said.

Ms. Satkoske's colleague, Amy VanDyke, who supervises medical ethicists in training at Mercy, said she has heard more discussion among the staff about Catholic values and ethics since the merger than she did before it.

"We have conversations about things we used to take for granted. We always assumed that everyone was on the same page because we are a Catholic hospital," she said. "Now we have those conversations regularly, on a daily basis."

Ann Rodgers: arodgers@post-gazette.com or 412-263-1416.


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