"There is an institutional explanation for the development of bioethics within Roman Catholic moral thought. Catholics, especially those in religious orders, have been institutionally involved in health care throughout its technological and institutional development. This is especially true of catholic involvement in hospitals over the last 150 years, the period in which health care developed into its present institutional form (Kaufmann, 1999). The moral questions raised in the institutional context of catholic health care, especially those involving difficult cases related to sexual morality, pregnancy, and end of life issues, provoked a pedagogical literature directed at nurses, physicians, and others. That literature is clearly continuous with, and an ancestor of, modern secular bioethics. Moreover, the institutional focus continues, for example, in the American bishops’ ‘’Ethical Religious Directives for Catholic Health Care Services (National Conference of Catholic Bishops, 1994 and 2001)"