COMMENTARY

Tell Patients When Religion Will Affect a Hospital's Care?

Arthur L. Caplan, PhD

Disclosures

February 23, 2017

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Hi. I am Art Caplan and I am in the Division of Medical Ethics at the New York University School of Medicine.

Sadly, this year I had a loss. My dad, at age 97, died. He died in an assisted-living nursing home facility in Framingham, Massachusetts. It was no more than 200 yards, I think, from the house he had lived in for the past 45 years. It was only in the final year of his life that we got him into this facility. It was ironic and interesting that the facility that he chose was a Catholic facility. He went to a home that was operated by nuns.

I asked him, "As someone who is Jewish, are you comfortable being in this type of place?" He said, "Sure." I said, "Do you plan to go to mass?" He said, "Absolutely. I am open to all kinds of experiences." He also jokingly said, "Look, I am close to dying." He knew he was going to die from colon cancer. He said, "I would like to cover all my bets, so it's no problem."

Well, for others, it may turn out to be a problem. Catholic institutions in the United States provide enormous amounts of care. Many hospitals are affiliated with the Catholic Church. It is certainly not a uniform form of affiliation. In some parts of the country, the people who run those hospitals pay close attention to Catholic doctrine and listen closely to what the cardinal in their area might say. In other parts of the country, less so. They do not think that the clergy have the same insights into caring for patients as long-time hospital administrators do.

What has been happening more and more, driven by economics, are mergers between secular places and either Catholic or other religiously affiliated hospitals, be they Mormon, Jewish, or whatever. But what happens if you have a merger of a public hospital or a secular hospital with a religious one? How do they handle religious hospitals that may have restrictions on what they are willing to provide—say, abortions, contraception, or infertility treatments? What do you do if the facility says it is not comfortable removing feeding tubes on religious grounds, or whatever the issue might be?

This is a tough question. In pluralistic America, you often have non-Catholic patients like my dad in a Catholic facility. You often have people who are less religious providing care, listening to more conservative views of what they ought to be doing, and maybe not being comfortable with that. There is a lot of room for conscience and a lot of room for division of opinion under many religious frameworks.

I will say one thing that I think is crucial: Whatever the policy of the institution, I think patients always have a right to know what their choices are and what their options are. You may go to a place that turns out to have a religious restriction on something that the patient might want. Let's say that it is physician-assisted dying in a state that has made it legal, but the institution says, "We do not do that here." Or the nursing home might say, "That is against our religious tradition. We do not offer it here."

Well, before going into a place, you need to know what the restrictions are, what the limits are, and what principles are going to guide care. Family and patients need to ask—and you need to tell them—if there are any limits or restrictions on what is going to be available. That is part of informed consent.

I think anybody—whether it is a young woman looking for contraception or an older individual who is seeking assistance in dying—has the right to know, as part of informed consent, what their options are. "If I cannot get it here, can I get it there?" "If you accept me here, does it mean that I will not get something? Then maybe I will go elsewhere."

If their choices start to become restricted because of mergers, then I think we are going to have to face a different issue. Can we carve out safe spaces where certain things that can be done that are not part of the hospital are near the hospital?

Right now, I think we should think hard about informed consent. Patients do have a right to know—before they come in—the nature of the terrain that they are going to face. Then they have a right to know—when they are inside a system—where else they could go if they want something that the system cannot provide but is legal to get.

I am Art Caplan. I am in the Division of Medical Ethics at the New York University School of Medicine. Thank you for watching.

Talking Points: Should Religious-Affiliated Hospitals Inform Patients in Advance About Their Religious Health-Related Principles?

Issues to consider:

  • According to a report from MergerWatch, as of 2016, 14.5% of all acute care hospitals in the United States are Catholic-owned or -affiliated.[1]

  • One in every six acute care hospital beds is in a facility that is Catholic-owned or -affiliated.[2]

  • In some states, more than 40% of acute care beds are in hospitals operating under Catholic health restrictions. US hospitals that are affiliated with the Catholic Church must adhere to a list of 72 ethical and religious directives issued by the United States Conference of Catholic Bishops.

  • In states like Colorado, which allow qualifying terminally ill adults to obtain a lethal dose of medication to voluntarily end their lives, Catholic hospitals that are opposed to the law will offer to transfer patients to another facility.

  • Colorado's aid-in-dying law contains "conscience" provisions allowing physicians, nurses, and pharmacists to "opt out" of participating. Health systems can also bar the practice on their premises. Other states where aid in dying has become legal-Oregon, Washington, California, Vermont, and Montana-have similar provisions, and Catholic healthcare systems in those states have taken advantage of it.

  • Last year, a federal court threw out a lawsuit from the American Civil Liberties Union that sought to force a Catholic hospital system to provide abortions against the church's teachings.

  • In some rural areas, Catholic-affiliated hospitals are the only provider of reproductive healthcare. Women who need even lifesaving abortions may be denied treatment and information.

  • There are nearly 20 million ER visits to Catholic hospitals every year, according to the Catholic Health Association of the United States.

  • Some pharmacies do not stock emergency contraception because of religious-based policies.

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