The news that two major Catholic health care systems, Ascension and Providence St. Joseph Health, are considering a merger that would create a nearly 200-hospital behemoth spanning 27 states raises questions about the expanded imposition of Catholic ethical norms on the health care system in the coming year.

In addition to the Ascension-Providence merger, two other large Catholic systems, Catholic Health Initiatives and Dignity Health have finalized merger plans for a new system that would comprise 139 hospitals over 28 states.

If the Ascension-Providence merger is finalized it would create the largest health system in the United States, which means that the largest single provider of health care in the country would be under the direction of the Catholic Church and bound by the Ethical and Religious Directives for Catholic Healthcare Services. The ERDs are promulgated by the U.S. Conference of Catholic Bishops and ban, among other services, abortion, contraceptive sterilizations, contraceptives, many assisted reproduction technologies, and assisted suicide.

While the hospitals currently under the control of these systems are already bound by the ERDs, the competitive advantage gained by these mergers will allow the Catholic systems […]