A recent study by the National Health Law Program reveals that an increasing number of patients are being denied medical care because of the religious, ideological, or personal views of the treating medical personnel or hospital. The kinds of care denied include abortion and contraceptive services, and sometimes even emergency contraception.
Ideological restrictions that allow individuals and institutions to deny patients care include refusal clauses (or conscience clauses). Refusal clauses allow medical personnel, on moral grounds, to not perform services otherwise required by law or medical guidelines. The ideological restrictions on care that refusal clauses allow are not based whatsoever on “patient need, evidence, or medical conditions, and, in fact, they often directly contradict medical practice guidelines and the standard of care” (PDF). Most states, including Pennsylvania, allow medical personnel to refuse to provide abortion and sterilization if the health professional is personally opposed to these procedures. Because of this ability to deny care, many patients end up less healthy after they leave a medical facility then when they entered it.
Susan Berke Fogel, the lead author of the report, said in a news release… “We reviewed policies at hospital systems representing more than 650 facilities across the U.S. and…we found a disturbing number of case studies where patients ended up far worse off either because their healthcare providers refused care or because their hospitals prohibited the care they needed for ideological or religious reasons.”
While it is upsetting enough that patients can be denied services such as abortion and sterilization, broader refusal clauses have recently been enacted. The farthest reaching is Mississippi’s, where medical personnel, institutions, and insurers can refuse to provide any service that they have an objection to (PDF).
Institutions controlled by religious entities have the greatest impact on access to care. The broadest of the religiously-based restrictions on care are those of Catholic health systems. Catholic health systems are governed by the Ethical and Religious Directives for Catholic Health Care Services. Physicians must agree to abide by the Directives to obtain admitting privileges at Catholic hospitals and other health care personnel are contractually bound to the Directives as a condition of employment. The Directives include, among other things, a prohibition on abortion even in the case of rape, incest, and the endangerment of the life of the woman (PDF). Evidence of the strict enforcement of the Directives may be seen in the recent case where a nun was excommunicated for providing a life-saving abortion.
The majority of patients treated at Catholic hospitals are not themselves Catholic. However, the one in six Americans who receive care at a Catholic hospital each year can only receive services allowed by the Directives.
A significant number of health care facilities are Catholic (15% of hospital beds in the U.S. are in Catholic hospitals and health care centers) or opposed to abortion for other reasons. For this reason, even physicians who intended to provide elective abortions after their residency often are prohibited from doing so because they happen to be employed by an anti-choice institution. Of the 30 physicians interviewed in a recent study, 18 intended to provide elective abortions after their residency. Only three ended up doing so, citing restrictions by their private group practices, employers, or hospitals.
Encouragingly, there have been several states that have introduced laws requiring emergency rooms (ERs) to provide emergency contraception (EC) to victims of sexual assault, the medical standard. However, many of these bills include refusal clauses. This means that even after passage of a bill requiring hospitals to give sexual assault victims the standard medical care, a sexual assault victim may still be denied necessary treatment if the treating health personnel or facility objects to it.
Because of refusal clauses, those who deny patients care are protected under law, even when their refusal to provide a service harms the patient. There have been small advances in making sure patients receive the health services recommended by medical guidelines with bills enforcing that ERs provide EC. However, even these bills may be tempered by refusal clauses. Patients, disproportionally female patients, are too often being denied care because of the views of the people who are supposed to be helping them.