In the 19th and early 20th centuries, religious rules for Catholic hospitals were published by various local and regional entities in America.

These posters hung on operating room walls in American and Canadian Catholic hospitals in the early 20th century.

[3] A report by the Catholic Theological Society of America found the Ethical and Religious Directives to be legalistic, inapplicable to concrete situations, and inferior to the Canadian Medico-Moral Guide.

The report strongly disagreed that local bishops should possess "sole ultimate authority" to evaluate the morality of new scientific developments, and called for less attention to sex and reproduction.

[3] Cardinal John Krol persuaded most American bishops to adopt the controversial 1971 document because of the legalization of abortion in Roe v. Wade in 1973 and Taylor v. St. Vincent's Hospital, a lawsuit by a woman seeking tubal ligation, in 1975.

[20] Within each hospital, the directives are enforced by ethics committees made up of clinical, religious, legal, and administrative members.

[17] At the time the Ethical and Religious Directives were first written, doctors in Catholic hospitals were not allowed to intervene in anything theologians considered a natural part of the reproductive process, even if deadly, such as ectopic pregnancy.

She says the hospital again denied her treatment when she returned with vaginal bleeding, days later, a delay which caused her fallopian tube to rupture.

[31] In national study of obstetrician-gynecologists in 2012, 5.5% of respondents at Catholic institutions reported that their options for treating ectopic pregnancy are constrained by their hospitals.

[33] The interpretation of the Catholic Medical Association rejects all emergency contraception after sexual assault, totally prohibiting Levonorgestrel (Plan B), Ulipristal acetate (Ella), insertion of an IUD, and all other measures a woman might use to avoid pregnancy after rape.