The Kaiser Family Foundation: Report - Is There A Common Ground?

Appendix A: Glossary

ABORTION:
Abortion refers to the spontaneous or induced termination of a pregnancy. The American College of Obstetricians and Gynecologists (1994) defines abortion as "expelling or removing the developing fetus from a woman's uterus before the fetus is viable (can live outside the uterus on its own). The medical procedure used to do this is induced abortion."

The National Conference of Catholic Bishops (NCCB 1995:19-20) defines abortion as "the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus." Accordingly, "every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion." Abortion, in this sense, is never permitted under Catholic doctrine. Where the direct intention of a termination of pregnancy is "the cure of a proportionately serious pathological condition of a pregnant woman," the procedure is not, strictly speaking, an "abortion" under Catholic doctrine. Such terminations of pregnancy to save the life of the woman are permissible "when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of unborn child." Most whom we interviewed regarding the availability of pregnancy terminations to save the life of the woman in a Catholic facility referred to this service as "therapeutic" or "medically necessary" abortion. In the report, we identify these services as "abortions to save the life of the woman."

ACQUISITION:
A type of affiliation in which one health care organization purchases another organization, which ceases to operate as a separate entity.

ALIENATION OF PROPERTY:
A concept under Catholic Canon Law, alienation is "either the conveyance to another party or the encumbrance or placing in jeopardy of loss any interest in the stable patrimony (immovable goods or fixed capital) of a public or juridic person" (Maida and Cafardi 1994:302).

ASSISTED REPRODUCTION:
Technologies to treat infertility in either the male or female partner and to enhance reproduction. (See "infertility treatments.")

CONSOLIDATION:
A type of affiliation in which two or more health care organizations dissolve and are unified in a new legal entity with one governing board and one CEO (Jaeger, Kaluzny, and Magruder-Habib 1992).

CONTRACEPTIVES:
Refers to methods or agents to prevent pregnancy (also called "birth control"). Distinctions are often made between surgical and non-surgical methods, reversible and irreversible methods, medical (requiring a physician's prescription) and non-medical, or natural and artificial methods. Methods of contraception currently in use include: surgical sterilization (male and female); oral contraceptives; contraceptive implants (Norplant); injectables (Depo-Provera); intrauterine devices (IUDs); diaphragms; condoms (male and female); spermicidal foams, suppositories, or creams; periodic abstinence; natural family planning; and withdrawal. The most prevalent methods in the United States are female sterilization and oral contraceptives.

COOPERATION:
See "principles of cooperation."

EMERGENCY CONTRACEPTION:
Oral contraceptives (sometimes called "morning after pills") taken to reduce the risk of pregnancy within 72 hours of unprotected intercourse.

FAMILY PLANNING:
Refers to the determination of the number of children and the spacing of children within a family by the use of contraceptive methods. (See "contraceptives.") Family planning services include provision of these methods along with education and counseling of the individual or couple.

HOLDING COMPANY:
In this type of affiliation, the holding company, a new legal entity, controls member health care organizations. The governing boards of the member organizations lose their power to the new holding company board. Member organizations still have separate balance sheets (i.e. assets and liabilities) and income statements (i.e. revenues and expenses).

INFERTILITY:
Stedman's Medical Dictionary (1990:780) defines infertility as "relative sterility; diminished or absent fertility; does not imply (either in the male or the female) the existence of as positive or irreversible a condition as sterility." U.S. medical experts consider a couple to be infertile after one year of unprotected intercourse without pregnancy (Chandra and Mosher 1994).

INFERTILITY TREATMENTS:
A variety of technologies to assist pregnancy, including, for example, artificial insemination (with spouse or donor sperm), in vitro fertilization, ovulation-inducing drug therapy, oocyte donation, embryo donation, and surrogate gestation.

JOINT VENTURE:
A type of affiliation in which two or more health care organizations develop an alliance or association (possibly a new corporate entity) for specific purposes. Partners continue to operate as independent providers (i.e. maintain separate governing boards, income statements, and balance sheets) and share ownership and governance of the new corporation.

LEASE AGREEMENT:
A contract that allows one party (the lessee) to use, possess, and manage assets of another party (the lessor) for a specified time and for a set payment. The lessor maintains ownership of assets. Assets may include lands, buildings, and property of health care facilities (Timmreck 1987).

MANAGEMENT CONTRACT:
A relatively loose type of affiliation between two health care organizations, in which one supplies senior management (e.g. chief executive officer, chief financial officer) to another (Jaeger, Kaluzny, and Magruder-Habib 1992).

MERGER:
A type of affiliation in which one or more health care organization is absorbed by another. Assets, liabilities, and income statements are merged. The result is one corporate identity, typically a system with a new name, one governing board, and one CEO (i.e. single ownership and governance). (See "virtual merger.")

OBSTETRICAL CARE:
Refers to the range of services associated with pregnancy and childbirth, including prenatal care, labor and delivery, and postpartum care of the mother.

PRECONCEPTION CARE:
Refers to educational, counseling, psychological, or genetic screening services to individuals or couples prior to conceiving a child.

PRENATAL CARE:
Refers to the care of a pregnant woman to maintain or improve her health, to prepare for childbirth, and to increase the likelihood that the pregnancy will result in a full-term, full birthweight, healthy infant.

PRENATAL GENETIC COUNSELING/SCREENING:
Genetic counseling refers to "a clinical service with informational, educational, and psychological components" about the likelihood that patients' offspring have "genetic (hereditary) conditions, defects, or diseases" (Slee, Slee, and Schmidt 1996:247). Prenatal genetic screening refers to the tests used prenatally to determine if a parent is a carrier of a genetic disorder or if a fetus has inherited a genetic disorder or predisposition.

PRINCIPLES OF COOPERATION:
The principle involves justifications for active participation in wrongdoing (Griese 1987). Cooperation in this sense is akin to complicity, that is, partnership or involvement in wrongdoing. The Directives distinguish between formal and material cooperation. Cooperation is "formal" when the form of the act (that is, its intention and object) is shared by both wrongdoer and cooperator. Formal cooperation is always morally wrong because the cooperator intends, either explicitly or implicitly, the object of the wrongdoer's activity. Cooperation is "material" when the act is achieved by participation of both wrongdoer and cooperator, although the cooperator may not share the intention of the wrongdoer. Material cooperation may be morally licit, depending on conditions of intention, duress (i.e. forces compelling collaboration), distance (i.e. between the cooperator and the evil act), necessity (i.e. extent to which the cooperation is necessary for the very existence of the wrongful activity), gravity (i.e. consequences of the evil), and the possibility of scandal. It is also important to evaluate proportionality (i.e. the ratio of good to evil) when an act of material cooperaton is considered (Keenan and Kopfensteiner 1995).

SCANDAL:
Refers to generating confusion about Catholic moral teaching (NCCB 1995:27). Scandal is said to occur when persons perceive an inconsistency between professed church teaching and reality. Because of scandal, people may become critical of the church and its members or cynical about religion. Finally, inconsistency between church teachings and practices is scandalous because by making evil seem good or seem like an attractive object, inconsistency may lead another to sin (Healy 1942; Smith 1987).

STERILIZATION:
Stedman's Medical Dictionary (1990:1475) defines sterilization as "the act or process by which an individual is rendered incapable of fertilization or reproduction, as by vasectomy, salpingectomy, or castration." Female sterilization typically is by tubal ligation or hysterectomy. Male sterilization is by vasectomy.

VIRTUAL MERGER:
A type of affiliation in which two or more health care organizations merge their income statements (revenues and expenses) but maintain separate balance sheets (assets and liabilities). A joint governing board representing the partners is formed and has some (but not ultimate) power over services provided by the partners. No new corporate identity is created. This type of affiliation has the advantage of allowing partners to maintain ideologically separate identities and tax status.