As Catholic provider Calvary grows, who decides what healthcare is made available?

Accessing IVF, abortion or voluntary assisted dying (VAD) can be difficult and complicated. It can be harder still in rural and regional areas, where specialist shortages, long delays, distance and conscientious objection already limit access.

That is why a Catholic provider’s decision to stop offering these services at Newcastle Private hospital in regional New South Wales has alarmed many clinicians and the community.

A local issue has exposed the potential for national implications. Calvary, a Catholic not-for-profit, is poised to take over 14 private hospitals from Healthscope, effectively doubling its private hospital network across the country.

Catholic providers already run about 6 per cent of Australia’s public and private hospitals. If the latest Calvary deal clears regulators, that footprint will grow, and so will doctors’ fears that access to legal healthcare will shrink.

These healthcare services have long attracted irreconcilable world views. But in 2026, they’re legal. The debate now has moved beyond what should be lawful, to who decides what care should be available.

A regional takeover

The catalyst for the Calvary controversy was a Teams meeting held Wednesday before last. Obstetricians and gynaecologists at Newcastle Private met with their incoming Calvary leadership team.

Most were stunned when they were informed that IVF, abortion, VAD, gender affirming care, contraception, vasectomies and tubal ligation — to prevent fertility — would all be off the table within a few weeks.

The doctors had assumed they’d have time to negotiate terms or find a solution to keeping these services on the hospital site. No such luck.

They would also have to sign a document pledging to practise in line with the Code of Ethical Standards for Catholic Health and Aged Care Services in Australia. The code calls abortion “morally wrong” and says procedures that substitute for the “marital act” are “not morally permissible”.

Calvary has acknowledged the “concerns and uncertainty within the community” and, late on Friday, more information was provided on its website.

“Where a requested intervention cannot be offered, we remain committed to treating every person with dignity, providing clear information and supporting access to appropriate ongoing care … Where a service is not offered, we will work with the treating specialist to support appropriate pathways.”

The push to separate religion from healthcare

The Catholic church has been unwavering in its teachings for hundreds of years. Even as arguments on issues such as IVF and abortion have shifted, its stance has remained constant.

The code that guides decision-making in Catholic hospitals describes itself, in its preface, as “a crucial resource for the Church’s mission in health care”. In practice, that means the church expects that its core and fundamental beliefs on sanctity of life and medical intervention should be upheld in a hospital setting.

But critics say that approach can create more barriers to clinical care.

IVF Australia’s Dr Veronica Knight calls Calvary’s latest decision, “discrimination based on religious ethos”.

The Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) is framing the issues as a matter of access, not ownership.

“We have no objection to Catholic ownership of hospitals,” RANZCOG President Dr Nisha Khot told the ABC.

“What we’re saying is that the law of the land says that all this health care is legal, and it should be available in every hospital. It should not be defined by the faith of the organisation that owns the hospital.”

The competition regulator recently cleared Calvary’s takeover of Hobart Private Hospital, where reproductive health, gender-affirming care and VAD were also due to be wound back.

RANZCOG’S concern is one of concentration. Dr Khot warned of scenarios “where the local public hospital and the private hospital are both Catholic”, leaving no hospital access for reproductive sexual health care or voluntary assisted dying.

Postcode lottery

Newcastle already offers a preview of what happens when VAD care meets a Catholic operator.

The region’s only public hospice sits within a hospital already run by Calvary as a public-private partnership. The hospital does not allow patients to have VAD drugs administered on-site, so patients who choose VAD must be moved to another bed — in another location — to die on their own terms.

Newcastle Private and Hunter Valley Private, the two hospitals Calvary is set to take over, have been making beds available where possible. If — or when — they stop offering that option, the pressure on health workers to find alternative beds will increase.

One VAD doctor, who cannot be named because of their contract with NSW Health, says the result could be waits that “blow out by several days”.

“There have already been cases where patients have been waiting for a couple of hours to transfer to another facility, in the final hours of their lives — sometimes in significant pain,” the doctor said. “And the longer they must wait, the risk is that patient loses the capacity to consent to taking the medication.”

Calvary’s decision to end services at Newcastle Private and Hunter Valley Private would leave patients to rely on workarounds.

Clinicians typically go to great lengths to make those succeed, and most Newcastle patients will likely still get care, but with more administration, delay and frustration.

Delay comes with risks. RANZCOG’s Dr Khot raises an extreme scenario, in which a woman at 18 weeks has her waters break at a Calvary hospital.

“She’s 18 weeks at a Calvary hospital, isn’t told about abortion as an option and doesn’t realise her life is at risk until sepsis sets in,” she said. This is hypothetical, but she says she’s “genuinely concerned” about it happening.

Abortion access is already uneven, particularly in rural and regional NSW, where public hospitals have turned women away.

In public hospitals, governments have levers. After ABC reporting revealed that Orange Hospital had told staff to stop providing terminations of pregnancy, the NSW health minister stepped in and reinstated the service.

The answer is less clear when the hospital is private, whether it is Catholic or not.

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No likely alternative

Calvary’s supporters, and even those who reject its doctrine, argue the Catholic health sector is worth protecting. Its roots go back to nuns who began caring for the sick and dying in Sydney in the late 1800s.

Federal Labor MP and doctor Mike Freelander puts the practical question bluntly: “What’s the alternative?”

In other words, if Calvary doesn’t take over Healthscope’s hospitals, who will, and who has the money to do it?

Dr Freelander says Catholic hospitals provide quality care, but is concerned the “Catholic ethical system is not keeping up with modern healthcare”.

Some have called on NSW Health to refuse to transfer the hospital licence unless Calvary keeps providing the services it plans to end. The Health Minister and Premier have ruled that out, saying the services will be available elsewhere, including at an already stretched public hospital.

That has done little to reassure providers working to avoid scenarios like eggs for IVF being driven across town because women can no longer have them retrieved at the private hospital next door to the clinic where embryos are created.

The ACCC is still assessing Calvary’s national expansion, but its test is whether the deal would substantially lessen competition, not whether patients lose access to services.

That leaves open the question: when care is legal, who decides whether or not it is provided?