A young Portland, Oregon area medical professional this year was fired for objecting to certain medical procedures on the grounds of her Catholic faith.
She was fired not from a secular hospital, however, but from a Catholic healthcare system— one that purports to follow Catholic teaching on bioethical issues.
"I definitely didn't think that there was necessarily a need to hold Catholic institutions accountable for being pro-life and Catholic, but I'm hoping to spread awareness," Megan Kreft, a physician assistant, told CNA.
"Not only is the fact that the sanctity of human life being undermined in our Catholic healthcare systems unfortunate— the fact that it's being 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 did anticipate some challenges as a pro-life person working in healthcare.
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 excuse herself from all of them.
She was able to work with the Title IX office to get a religious accommodation while in school, but ultimately her medical school experience led her to rule out working in the fields of primary care or women's health.
"Those areas of medicine need providers who are committed to standing up for life more than any," she said.
It was a tough decision, but she says she got the sense that the medical professionals who work in those fields tend to be more accepting of objectionable procedures like abortion or assisted suicide.
"We're called in the field of medicine to really care for mind, body, and spirit," she pointed out, adding that she as a patient has struggled to find life-affirming medical care.
Still, Kreft wanted to be open to whatever God was calling her to, and she came across a physician assistant position with 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 hopeful that at least my desire to practice medicine consistent with my faith and conscience would be at least tolerated, at a minimum," Kreft said.
The clinic offered her the job. As part of the employment process, she was asked to sign a document agreeing to conform to the institution's Catholic identity and mission, and to the US bishops’ Ethical and Religious Directives for Catholic Health Care Services, which provide authoritative Catholic guidance on bioethical problems.
To Kreft, it seemed like a win-win. Not only would a Catholic approach to healthcare be tolerated in her new workplace; it seemed it would, at least on paper, be mandated, not just for her but for all employees. She happily signed the directives and accepted the position.
Before Kreft started work, however, she says one of the administrators at the clinic reached out to her to ask what medical procedures she would be willing to offer as a PA.
On the provided list— in addition to many benign procedures such as stitches or toenail removal— were such procedures as vasectomies, intrauterine device insertions, and emergency contraception.
Kreft was quite surprised to see those procedures on the list, because all of them go against the ERDs. But the clinic offered them to patients quite openly, she said.
It was discouraging, she says, but she vowed to stick to her conscience.
Within the first few weeks of work, Kreft said she had a physician recommend that she refer a patient for an abortion. She also found out that the clinic encouraged providers to prescribe hormonal contraception.
Kreft reached out to the clinic's administration to tell them that she did not plan to participate in or refer for those services.
"I didn't think I had to be explicit with that, because again, the organization said these were not services that they provided," Kreft pointed out, "but I wanted to be up front and find a way forward."
She also reached out to the National Catholic Bioethics Center for advice. Kreft said she spent many hours on the phone with Dr. Joe Zalot, a staff ethicist at the NCBC, strategizing on how to approach the ethical dilemmas she was facing.
Most people are not aware of the nuances of Catholic bioethics, and the NCBC exists to help healthcare providers and patients with those questions, Zalot told CNA.
Zalot said the NCBC frequently gets calls from healthcare professionals who are being pressured to act in a way that violates their conscience. Most of the time, it's Catholic clinicians in a secular system.
But every once in a while, he said, they receive calls from Catholics working in Catholic healthcare systems, like Megan, who are being similarly pressured.
"We see Catholic healthcare systems doing things they shouldn't do, and some are worse than others," he commented.
Kreft talked to her clinic manager and the chief mission integration officer about her concerns, and was told that the organization "does not police providers," and that the patient-provider relationship is private and sacred.
Kreft found the clinic's reply unsatisfactory.
"If you're a system that doesn't value the [ERDs], and you see them as red tape and aren't going to put in the effort to see that they're integrated or that staff and providers understand them— it's almost better not to [sign them]. Let's be consistent here; I was receiving very mixed messages," Kreft said.
Despite the clinic’s insistence that it "does not police providers," Kreft believed her healthcare decisions were being policed.
Kreft says her clinic manager at one point told her the clinic's patient satisfaction scores could go down if she didn't prescribe contraception. Eventually, the clinic prohibited 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 whom she had seen previously for an issue unrelated to family planning or women's health. But at the end of the visit, she asked Kreft for emergency contraception.
Kreft tried to listen compassionately, but told the patient that she could not prescribe or refer for emergency contraception, citing Providence's own policies on the matter.
However, when Kreft stepped out of the room, she realized that another healthcare provider had stepped in and was prescribing the patient emergency contraception.
A few weeks later, the regional medical director called Kreft in for a meeting and told Kreft that her actions had traumatized the patient, and that Kreft had "done the patient harm" and thus had broken the Hippocratic Oath.
"Those are big, significant claims to make about a healthcare provider. And here I was operating out of love and care for this woman, care for her from a medical and spiritual standpoint," Kreft said.
"The patient was experiencing trauma, but it was from the situation she was in."
Later on, Kreft approached the clinic and asked if they would allow her to take a course in Natural Family Planning for her continuing education requirement, and they refused because it was "not relevant" to her job.
The ERDs state that Catholic healthcare organizations have to provide NFP training as an alternative to hormonal contraception. Kreft said she was not aware of anyone at the clinic being trained in NFP.
Eventually, the clinic's leadership and HR informed Kreft that she had to sign a performance expectation document, stating that if a patient requests a service that she herself does not provide, Kreft would be obliged to refer the patient to another Providence healthcare provider.
This would involve Kreft referring for services that she in her medical judgement saw as a detriment to the patient, such as tubal ligations and abortions.
Kreft says she wrote to the health system leadership, reminding them of their Catholic identity and asking why there was such a disconnect between the ERDs and the hospital's practices. She says she never received a response.
In October 2019, she was given a 90-day notice of termination 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, but was fired in early 2020.
Her goal in settling, she says, was to be able to tell her story freely— something 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 Office of Civil Rights 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 could even pull federal funding if violations continue.
She 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 by practicing pro-life healthcare, she had wanted to be "one small light" in her clinic, but that was "not tolerated or permitted in the organization at all."
"I expected [opposition] in a secular hospital, where my training was, but the fact that it's occurring within Providence is scandalous. And it's confusing to patients and their loved ones."
She recommended that any healthcare professional facing an ethical dilemma contact the NCBC, as they can help to translate and apply the Church's teachings to real-life situations.
Zalot recommended that all Catholic healthcare workers familiarize themselves with the conscience protections in place at the hospital or clinic where they work, and if necessary seek legal representation.
Zalot said the NCBC is aware of at least one physician within the Providence Health System signing off on assisted suicides.
In another recent example, Zalot said he received a call from a healthcare worker at a different Catholic healthcare system who was observing gender-reassignment surgery taking place in their hospitals.
If workers or patients observe Catholic hospitals doing things contrary to the ERDs, they should contact their diocese, Zalot advised. The NCBC can, at the invitation of a local bishop, perform an "audit" of a hospital's Catholicity and present the bishop with recommendations, he said.
Kreft is, in some ways, still reeling after being fired six months into her first medical job.
Though she is not entirely sure what God is calling her to next, she is looking to get involved with My Catholic Doctor, a national telehealth platform, to teach NFP and provide primary care services, with the goal of someday transitioning back to a brick and mortar clinical practice.
In the meantime, she's trying to be an advocate for others who may be in a situation similar to hers, and hopes to encourage Catholic hospitals to choose to reform, and provide "the life-affirming healthcare that they were founded to provide."
"There are probably other healthcare providers, even within Providence, that have experienced similar situations. But I imagine Providence is not the only Catholic healthcare system in the country that struggles with this."