Health Care, Religion, and Conscience: An Institutional and National Dilemma

Numerous studies have demonstrated that religious beliefs are a strong force, whether consciously or unconsciously, in the medical advice and decision making of doctors. But what happens when the religious or moral beliefs of health care practitioners conflict with institutional or national health care policies?   

New research reveals that one in five primary care physicians who practice in religiously affiliated hospitals say they have faced “clinical ethical conflicts” when treating patients, where end-of-life care, abortion and other practices are restricted. This is all the more an issue given that religious hospitals represent nearly 20 percent of the American health care system. 
 
This challenge has been highlighted by several cases over the last few years. In Phoenix in 2009, a bishop excommunicated a longtime administrator, Sister Mary McBride, for permitting an abortion at St. Joseph Hospital in order to save the life of the mother. When the bishop insisted the hospital no longer conduct such procedures in the future, the board refused and Bishop Thomas Olmstead decertified the hospital as a Catholic institution. Olmstead explained that while he did not want to take such measures he felt that the "faithful of the diocese have a right to know whether institutions of this importance are indeed Catholic in identity and practice." 
 
The other side of this issue is the concern that attempts to compel doctors and religious institutions to offer all procedures through legislation or otherwise will force them to compromise religious beliefs and values.   One example of this concern being realized was in the spring of 2009 when a nurse at Mount Sinai Hospital in New York was compelled to assist in the late term abortion of a mother in her second trimester. 
 
The resulting controversy drew out the debate on the Provider Refusal Rule, better known as the “conscience clause” which allows health care providers to refuse to participate in procedures they find objectionable for moral or religious reasons. This rule was implemented by President George Bush in 2008 in order to protect “the right of medical providers to care for their patients in accord with their conscience.” In 2009 the Obama administration proposed to rescind the rule, asserting that  it “would limit access to patient care and raised concerns that individuals could be denied access to services.”  

Needless to say, the decision that is ultimately reached regarding the “conscience clause” will have a significant impact on the policy of health care providers regarding the religious beliefs and conscience of patients and practitioners. Conflicts based on religious beliefs in the health care setting, on an institutional and national level, call for a need for continued dialogue. Through our work here at Tanenbaum, we hope to continue to work towards promoting open dialogue surrounding these issues.