Catholic hospitals may not sterilize women by cutting or tying their Fallopian tubes -- even for medical reasons -- under a new directive released yesterday by the National Conference of Catholic Bishops.

The Catholic Church has always opposed sterilization of both men and women, but some Catholic hospitals have continued to perform so-called tubal ligations when a woman's life would be endangered by pregnancy. The new directive appears to prohibit that.

The bishops specifically said the idea that a diseased organ may be sacrificed to save the life of an individual "does not apply to contraceptive sterilization and cannot be used to justify it."

A commentary accompanying the one-page statement acknowledges "the problems faced by married couples for whom a pregnancy might pose serious risks to the life and health of the mother, or possibly might lead to the conception of a child seriously crippled by a genetically induced disease." t

The solution suggested in the commentary, written by Dr. William E. May, a lay theologian at Catholic University, is for the couples to abstain from sex, if natural family planning methods don't work, and concentrate on their spiritual life.

"Such couples need the help of the church and of Christ," May wrote. "Many couples, both Catholic and non-Catholic, when faced with this sort of problem, have decided to forgo the genital expression of their love, in order to refrain from doing evil [submitting to sterilization], and to open their hearts to the reign of God."

The statement did say that tubal ligations could be performed for "grave reasons extrinsic to the case" -- such as when a hospital would be forced to close if it refused to perform the procedure, according to one theologian who helped draft the statement.

The directive, mailed over the Fourth of July weekend, had not yet reached most Catholic hospitals and officials were reluctant yesterday to comment on it.

At Georgetown University Hospital, Dr. John Queenan, head of the obstetrics gynecology department, said the "existing policy" was to permit tubal ligation in two circumstances.

It is permitted when a woman's uterus has "intense defects after several Cesarean sections. And, in cases where the mother could not deliver a live baby because of genetic or other reasons, "her case would be presented to a board and if it was agreed that her life and health is in danger, we would perform a tubal ligation."

At Georgetown, Queenan said, "we turn to the clergy and say, 'Help us think these things through. But they don't look over my shoulder in the operating room."

Sister Irene Kraus, president of Providence Hospital, said that while she has not seen the new statement, she expected it would have little effect on her hospital since it performs no tubal ligations.

"We don't do them," she said. "The doctors know that if they have a patient that needs it, they admit them somewhere else."

However, there are many communities throughout the South and Far West where the only hospital in town is a Catholic one. Many of those are staffed by non-Catholic doctors and serve largely non-Catholic populations.

Sister Joan Upjohn, administrator of Holy Cross Hospital in Salt Lake City and chairman of the board of the Catholic Health Association, pointed out that in most Catholic hospitals, "when a doctor comes on the staff, he signs a statement that he will abide by the Catholic moral code."

Nevertheless, there have been two recent court cases -- one in Michigan and one in Montana -- in which patients and/or their doctors tried to force a Catholic hospital to allow tubal ligations to be performed there. The courts upheld the church in both cases.

While unequivocally prohibiting tubal ligations for medical reasons, the bishops' statement does acknowledge "grave reasons extrinsic to the case" that may justify the procedure.

According to Msgr. Richard Malone, a theological consultant to the bishops' conference, that means legal pressures that might be exerted to force a hospital to perform such procedures.