(RNS) In the wake of public spats between the Catholic hierarchy and health care executives, the Catholic Health Association publicly acknowledged that bishops — not doctors or hospital ethicists — have the final say on questions of medical morality.

The concession came in letters made public on Monday (Jan. 31) between Sister Carol Keehan, president and CEO of the Catholic Health Association, and Archbishop Timothy Dolan of New York, president of the U.S. Conference of Catholic Bishops.

Disputes between health care executives and bishops have intensified as Catholic authorities wrestle with increasingly complex moral quandaries in the country’s more than 600 church-affiliated hospitals.

Keehan has clashed with the bishops over the new health care law and a controversial surgery at an Arizona Catholic hospital that Phoenix Bishop Thomas Olmsted called an abortion. Olmsted later stripped St. Joseph’s Hospital and Medical Center of its Catholic status and excommunicated its chief ethicist, Sister Margaret McBride.

Keehan had backed the hospital in the dispute, saying it had correctly interpreted the Ethical and Religious Directives for Catholic Health Care Services, a set of moral guidelines written by the USCCB.

In her letter, Keehan conceded that only a bishop’s interpretation of the Ethical and Religious Directives is authoritative. A bishop also has the right “to develop his own ethical and religious directives if he chooses,” Keehan wrote.

Dolan underscored the point.

“Where conflicts arise, it is again the bishop who provides the authoritative resolution based on his teaching office,” he said.

“Once such a resolution of a doubt has been given, it is no longer a question of competing moral theories or the offering of various ethical interpretations or opinions of the medical data that can still be legitimately espoused and followed,” Dolan added.

The letters followed conversations between Keehan, Dolan, Bishop Robert Lynch of St. Petersburg, Fla., a member of the CHA board of directors, and Bishop Kevin Vann of Fort Worth, the bishops’ liaison to the CHA, according to the USCCB.

Last year, the CHA and groups of Catholic sisters bucked the bishops by backing President Obama’s health care reform.

Dolan said the CHA and the bishops should now work together for legislation that would ensure no federal money is used for elective abortions and to strengthen conscience protections for Catholic health care workers.

“The purpose of these letters is to put all this behind them and move on with a united legislative strategy on both the federal and state level,” said the Rev. Thomas Reese, an expert on the bishops and a senior fellow at Georgetown University’s Woodstock Theological Center.