In Texas, a Catholic bishop made two hospitals cease doing tube-tying operations for women who are not going to have more babies. In Oregon, another bishop cast a medical center out of his diocese for refusing to discontinue the same procedure.
In Arizona, a nun was excommunicated and the hospital where she works was expelled from the church after 116 years for allowing doctors to terminate a pregnancy to save a woman's life.
Such disputes between hospitals and church authorities appear to be arising because of a confluence of factors: Economic pressures are spurring greater consolidation in the hospital industry, prompting religiously affiliated institutions to take over or merge with secular ones, imposing church directives on them.
At the same time, the drive to remain competitive has led some medical centers to evade the directives. Alongside those economic forces, changes in the church hierarchy have led increasingly conservative bishops to exert more influence over Catholic hospitals.



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