Seton Medical Center Austin (Texas), the city's largest medical and surgical acute care center and part of Catholic health system giant Seton Healthcare, requires patients who miscarry to consent to holding fetal burials, The Texas Observer reports.
One patient who had a miscarriage in June 2015 scheduled a procedure at her physician's suggestion at Seton Medical Center to remove the tissue from inside her uterus. Before heading into surgery, a nurse handed the patient a document asking her to consent to the burial of the fetal remains. The patient could either let Seton bury the remains in a shared grave, or she could schedule a private burial at her own expense.
When the patient asked if she could opt out of the burial, the nurse shook her head, and sent a social worker to speak with her, who told the patient again that she could choose between the two burial options, according to the report.
The patient chose to leave the burial up to the hospital and opted not to be notified when the burial occurred. "At that point, my only alternative would have been to disconnect the IVs and walk out and have to figure out how to deal with the missed miscarriage some other way," she told The Texas Observer.
Seton, which follows the religious directives of the Catholic Church, has required the burial of all fetal remains after miscarriages for over a decade and does not perform abortions or offer contraceptives. One of the hospital's physicians provided a copy of the policy to The Texas Observer. "As a catholic institution, the Seton Healthcare Family policy is for all loss of life to be given a proper burial," the policy reads.
Seton spokesperson Adrienne Lallo defended this policy to The Texas Observer, questioning whether there was any alternative to burial. "What would happen normally?" Ms. Lallo asked. "What would people like us to do, other than offer free burial?"
However, the hospital's policy is not common. In miscarriage cases, medical facilities usually incinerate remains and send them to a sanitary landfill, as they would with any other medical waste. Families may take the fetal remains and arrange a burial if they choose, according to Texas law.
"If people don't want the remains buried in a Catholic cemetery, they can take responsibility for handling the remains. If they don't take responsibility for that, it's taken care of by the healthcare system," Ms. Lallo said. "It's important to emphasize that we're trying to do the right thing, by taking care of folks mainly who are disconsolate, and already dealing with a lot."
Seton confirmed to The Texas Observer that if a woman will not sign the waiver, the hospital will still eventually bury the remains. "If they don't make a decision even after we follow up, we'll proceed with a respectful burial," according to Ms. Lallo. "Because that's the way we are comfortable caring for the remains."
Hospital physicians who disagree with Seton's policy said they warn patients before for they pursue surgery following miscarriages. "I don't think most patients consider this. In general it's very upsetting," said Diana Weihs, MD, an Austin OB-GYN and former chief of the obstetrics and gynecology section of Seton Medical Center.
Karen Swenson, MD, who formerly served as chief of staff at Seton Medical Center Austin and president of the medical staff at Seton Family of Hospitals, also refers patients elsewhere for surgery following miscarriages due to the distress they see the burial policy causes patients.
"[Most patients] think they're in a healthcare facility, and that the religious part is the practice of medicine in a compassionate and caring way, not the following of religious and ethical directives of the Catholic Church," Dr. Swenson said.
More articles on clinical leadership and infection control:
Mayo Clinic infectious diseases physician aids fellow passenger during in-flight medical emergency
Report: Low surgery volumes at military hospitals may harm patients
The risk physicians face for reporting patient harm: 7 insights