A Hospital's Religious Affiliation Affects Patient Care

If your doctor's treatment plan conflicts with the hospital's religious policies, who gets the last word?

April 15, 2010

At some hospitals, doctors may feel pressured to adust their care along religious lines.

RODALE NEWS, EMMAUS, PA—This week president Barack Obama issued a memorandum requiring hospitals that receive Medicare or Medicaid funding to permit visits by partners in same-sex couples. But hospital policies can have a more subtle effect on the experience of the patients who stay there, according to new research in the latest Journal of General Internal Medicine. Turns out, the policies of religiously affiliated hospitals can be at odds with your doctor's opinion, meaning you may have to look elsewhere for a procedure your doctor thinks you need.


THE DETAILS: The study researchers mailed surveys to 446 internists, family doctors, and general practice physicians across the country. Forty percent said they had worked at a religiously affiliated hospital, the most common being Roman Catholic, followed by other Christian denominations then Jewish-affiliated hospitals. In response to the question, "Have you ever had a conflict with that hospital regarding its religiously based policies for patient care?", one in five doctors answered yes. When asked, "What should a physician do if he/she believes that a patient needs a medical intervention, and the hospital where the physician works prohibits that intervention because of religious affiliation?", 86 percent said doctors should encourage the patient to seek treatment at another hospital, while 10 percent said doctors should recommend an alternative treatment acceptable to the hospital. Just 4 percent said they would provide the prohibited treatment in violation of hospital policy, which would risk their job and hospital privileges.

WHAT IT MEANS: Your doctor may not always agree with a hospital's religious policies, but those policies can still affect your care, says lead study author Debra Stulberg, MD, instructor in the department of family medicine at the University of Chicago. "This is not a very well understood problem," she notes. "We're just beginning to get a sense of what physicians are experiencing."

The study didn't look at which policies caused the most conflict, but Dr. Stulberg says that from personal and anecdotal experience, reproductive health and end-of-life issues are the most contentious. For instance, she says, if a rape victim visits an emergency room, standard hospital procedure calls for providing the victim with emergency contraception. However, "according to some Catholic hospitals, that treatment is considered abortion and is not allowed," say Dr. Stulberg. In such time-sensitive situations, she adds, sending that patient to another hospital would delay care and reduce the effectiveness of treatment. It's these emergency situations that tend to be the most problematic. "Sometimes a situation arises that a doctor doesn’t expect, and the doctor discovers only at that moment that the hospital doesn’t allow the treatment."

Another contentious issue is the use of artificial nutrition and hydration (feeding tubes). A hospital may be at odds with a family member who doesn’t want his or her loved one who is in a vegetative state to get a feeding tube. Sometimes the patient himself has requested beforehand not to be put on a tube. "Some hospitals are more responsive to these requests, but others are more rigid," says Dr. Stulberg. "They say these are the policies and you have to follow them."

On the one hand, it's encouraging that doctors are so willing to refer patients to other institutions where a contentious procedure can be performed, believes Dr. Stulberg. On the other, that could be a problem for people who may not have the option of going elsewhere because they live in a rural area or because their insurance won't pay. "From the hospital's standpoint, it's easy to say that a person can find someplace else to go," says Dr. Stulberg. "But the reality is that people don't always have another place to go."

The best way to protect your rights as a patient is to discuss matters with your doctor as well as your preferred hospital:

• Find out where the doctor stands. Federal law allows doctors to deny treatments to patients based on moral grounds, even if the physician is not affiliated with a religious hospital. So it’s important to discuss reproductive health, end-of-life issues, or any other concerns you have so you know where your doctor stands. For instance, if you need to go on birth control, ask if your doctor has any objections. In rare cases, doctors won't provide this, and you may have to pay out-of-pocket to see a doctor who will.

• Find out where the hospital stands. If your preferred hospital has a religious affiliation, ask about its policies. "Roman Catholic hospitals and some other Christian denominations, such as Adventists, tend to have clear, written, policy statements you can check," says Dr. Stulberg. Also, Catholic hospitals usually have the strictest guidelines, she adds. "Others, such as Lutheran, Methodist, or Jewish hospitals, may have statements of values and what it means for them to be religiously affiliated, but those statements don't always specifically say what's allowed and what's not allowed."

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