Doctors at religious hospitals face ethical conflicts over care

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Doctors at religious hospitals face ethical conflicts over care

Most physicians in a recent survey said they would refer their patients

elsewhere for barred services, but 4% would violate hospital policy to provide

care.

By B. O'Reilly, amednews staff. Posted May 3, 2010.

One in five primary care physicians working in religiously affiliated health

care organizations has experienced a conflict over faith-based patient care

policies, according to a new study in the Journal of General Internal Medicine.

The findings, based on a nationwide survey of 446 family physicians and

internists, appear to be the first to document how frequently doctors disagree

with institutional policies in areas such as reproductive and end-of-life care,

said Debra B. Stulberg, MD, the study's lead author.

" It's an issue that patients and we, as physicians, should be aware of, " said

Dr. Stulberg, instructor in the Dept. of Family Medicine at the University of

Chicago Pritzker School of Medicine.

Most of the physicians reporting conflicts worked in Catholic hospitals, which

account for 12.5% of all U.S. community-based hospitals and 15.5% of hospital

admissions, according to the Catholic Health Assn. of the United States.

Catholic hospitals are required to follow the U.S. Conference of Catholic

Bishops' religious directives on medical care that bar contraception, abortion

and sterilization and, in many instances, rule out ending artificial hydration

and nutrition.

12.5% of all U.S. community-based hospitals are Catholic.

When conflicts arise, 86% of surveyed physicians said they would encourage

patients to seek the recommended care at another hospital. Ten percent said they

would offer an alternative treatment that could be delivered at the religious

hospital, and 4% endorsed violating the hospital's policy to provide the care.

Referring patients to another hospital may not be in the patient's best

interests, said Dr. Stulberg, particularly for time-sensitive interventions such

as emergency contraception. Referrals also can impede access to care for

patients who live in underserved rural areas or lack access to transportation,

she said.

" Telling the patient they have to go someplace else can, at the very least,

introduce a delay in getting the care, " Dr. Stulberg said. " That concerns me. "

Physicians' dilemma

The study, published online April 6, highlights how religious policies can

interfere with physicians' medical judgment, said Lois Uttley, director of the

MergerWatch Project. The New York City-based group opposes health care

organization mergers between Catholic and nonsectarian hospitals that result in

reduced access to reproductive care services.

" This is a very urgent problem and has been understudied. Until now, the balance

of research and public policy in this country has focused on physicians and

hospitals that want to refuse to provide certain health services because of

their religious or moral beliefs, " Uttley said. " What we haven't seen given

proper attention is the ethical dilemma facing physicians who want to provide

services because their patients need the services but who are unable to do so

because of institutional religious restrictions. "

Catholic hospitals bar contraception, abortion and sterilization.

s, MD, said the study does not raise serious concerns about access

to care.

" Physicians approach this issue like they approach a lot of issues, " said Dr.

s, CEO of the 15,000-member Christian Medical & Dental Assns. " They have a

patient with a certain problem and they look for the best place to care for that

problem ... This is much ado about very little. "

The real problem, he said, is that physicians who oppose practices that conflict

with their religious faith face increasing pressure to violate their deeply held

beliefs. The outgoing Bush administration addressed that concern, issuing a

December 2008 rule authorizing the Dept. of Health and Human Services to deny

federal funds to health care organizations found discriminating against health

professionals who object to providing abortion-related services.

The Obama administration pledged in March 2009 to rescind the rule, but has yet

to take action on the issue. The White House referred an American Medical News

query on the matter to HHS, which did not respond by this article's deadline.

The American Medical Association has policy that opposes requiring doctors to

perform procedures that violate their moral principles.

Uttley said that, with health system reform enacted, the Obama administration

should take action and rescind the Bush conscience rule.

The print version of this content appeared in the May 10, 2010 issue of American

Medical News.

" Religious Hospitals and Primary Care Physicians: Conflicts over Policies for

Patient Care, " Journal of General Internal Medicine, published online April 6

(www.ncbi.nlm.nih.gov/pubmed/20373045)

http://www.ama-assn.org/amednews/2010/05/03/prsb0503.htm