USA: Doctors at religious hospitals face ethical conflicts over care

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CHICAGO, Illinois / American Medical News / Profession / May 3, 2010

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 Kevin B. O'Reilly, amednews staff.

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.

2.5% 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." [rc]

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Reference:
"Religious Hospitals and Primary Care Physicians: Conflicts over Policies for Patient Care," Journal of General Internal Medicine

Copyright 2010 American Medical Association.