Following are excerpts from stunning 2010 Report, entitled “Health Care Refusals: Undermining Quality Care for Women,” written by Susan Berke Fogel, J.D., and Tracy A Weitz Ph.D., M.P.A.
Two of the 13 advisors to the project are Don Downing, Clinical Associate Professor, University of Washington, Department of Pharmacy; and Nancy F. Woods, Dean, School of Nursing and Professor, Family and Child Nursing, University of Washington.
Editor’s note: This report should be read by everyone seeking to understand how Catholic health care compromises a woman’s health care.
The American College of Obstetricians and Gynecologists has recognized that a patient’s health should always come first, and that access to health services should be based on the patient’s medical needs, not the provider’s personal or religious beliefs. ACOG states that the patient’s autonomy, and physical and mental health, limit the physician’s ability to refuse. ACOG recommends that a provider’s personal beliefs can be accommodated only when the primary duty to the patient can be fulfilled; providers must give patients full, accurate and unbiased information; providers have a duty to refer; and in an emergency, providers have an obligation to provide needed care regardless of the provider’s personal objections. – page 8
Health care is not like other fields. The delivery of health care is highly regulated, with good reason. … Restrictions of information and services do not take place in an open marketplace. The provider-patient relationship is inherently unequal, and the denial of information or services directly impacts the patient’s health and well-being. Contemporary debates over refusals and denials of care have disproportionately focused on philosophical issues of balancing patients’ rights and providers’ beliefs. The framing fails to address the real life consequences refusals and denials of care have for patient health…..the failure of health care professionals to provide information regarding or access to specific types of health care is not solely an exercise of individual conscience but rather the provision of substandard care. – page 10
Evidence-based practice requires that health care decision-making is based on the best available scientific research, seeking to improve the quality and decrease the cost of health care by ensuring that patients receive treatments known to be effective and not receive those treatments proven to be ineffective or harmful. – page 11
…health care denials and prohibitions grounded in personal and religious beliefs rather than scientific evidence negate evidence-based practice, patient-centered care, and prevention. They take women’s reproductive health backwards to the discredited model of paternalistic health care where treatment decisions are made by physicians and health systems regardless of patient needs and preferences. – 12
Access to scientifically-grounded health care information and services related to contraception and pregnancy termination are critical to the health of women, as is care and information related to fertility attainment and healthy sexuality. Decisions to deny information and services based on personal and religious beliefs rather than scientific evidence ultimately result in poor health outcomes for women.
Informed consent, a key tenet of professional ethics, means providing patients with the information they need to select among health care options. By allowing or requiring health care providers to offer patients incomplete information about treatment alternatives, public policies deny informed consent, undermine standards of care, and contribute to poor health outcomes. These denials disproportionately impact women’s health care. – page 13
If some health care professionals fail to provide information regarding and access to, specific types of health care based on factors other than patient need or scientific evidence regarding the effectiveness of the health care service, affected patients will bear unreasonable burdens. For example, an ectopic pregnancy is a pregnancy that develops outside the uterus, most commonly in the fallopian tube. If not removed the ectopic pregnancy poses a serious risk to the woman’s health and could result in death. The American College of Obstetricians and Gynecologists …recognizes three medical approaches to terminate an ectopic pregnancy; drugs to dissolve the pregnancy, minimally invasive laparoscopy, or invasive surgery to remove a portion of the fallopian tube. All of these medical guidelines require that the procedure selection is based on the patient’s medical condition and preferences.
Catholic health restrictions, however, take that decision out of the hands of patients and physicians and may prohibit some treatment options such as the use of medications to dissolve the pregnancy. This limit is based on the religious view that the use of such medications constitutes an abortion, even though an ectopic pregnancy will never result in a viable pregnancy. This restriction may deny the patient the least invasive and potentially best option to preserve her future fertility – page 14.
…when physicians are prohibited from providing care in accordance with their clinical judgment, because of the ideology of the institution in which they are employed, patient care is …negatively affected.
Ideological restrictions are denials of care based on the provider’s or providing institution’s ideological, personal or religious beliefs. Ideological restrictions are not governed by patient need, evidence, or medical conditions, and in fact, they often directly contradict medical practice guidelines and the standard of care.
The largest group of restrictions, and the ones that have the greatest impact on access to care, are imposed by religious entities. The largest religiously-controlled health systems are Catholic….the Catholic health systems are the only ones to have a hierarchical system of rule-making and enforcement which is maintained by their relationship to the local Bishop, the United States Conference of Catholic Bishops, and ultimately to the Vatican.
…the four largest Catholic hospital systems reported nearly $29 billion in net patient revenues in 2006. Most of the patients served in these facilities are not themselves of the Catholic faith or adhere to the doctrine as enforced by the Catholic bishops.
The (Ethical and Religious) Directives substitute religious doctrine for the standard of care, and there are no expections for rape, incest, the health or life of the person, medical necessity, or the informed decision of the patient. The prohibition on elective abortion extends beyond elective abortions and applies to the direct termination of any pregnancy, even when the pregnancy is putting gthe woman’s health or life at risk. Under the Directives, treatment options are not subject to patient control or physician recommendation. – Page 18
Patient care in religiously-based institutions, therefore is largely unpredictable and is ultimately compromised when neither patients nor communities have accurate information about available services and access to medical interventions according to the standards of care.
Informed consent – disclosure of information about what will happen to the patient so that s/he can competently and voluntarily make a decision about whether or not to undergo the advised intervention is at the core of the individual’s right to make his or her own decisions about medically appropriate health care.Informed consent as come to be associated with disclosure of the following six items to the patient or their guardian: 1) diagnosis; 2) nature and purpose of the proposed treatment; 3) risks and consequences of the proprosed treatment; 4) probability that the proposed treatment willb e successful; 5) feasible treatment alternatives; and 6) prognosis if the proposed treatment is not given.
Informed consent is a core ethical as well as legal tenet for physicians according to the American Medical Association. – Page 19
Directive 26. (Editor’s note – this refers to ERD Directive number 26 from the Ethical and Religious Directives for Catholic Health Care)
Free and informed consent requires that the person or the person’s surrogate receive all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all.
Each person or the person’s surrogate should have access to medical and moral information and counseling so as to be able to form his or her conscience. The free and informed health care decision of the person or the person’s surrogate is to be followed so long as it does not contradict Catholic principles. – page 22
Health care refusals and institutional denials of care grounded in personal and religious beliefs rather than scientific evidence negate evidence-based practice, patient-centered care, and prevention. The patients needs and preferences are made invisible, and she may lack the information necessary to make informed decisions. Last, institutional restrictions prohibit health care professionals from meeting the standards of their profession and their patients’ needs. – page 23