Religious hospital policies that limit reproductive health care are poorly understood by patients, according to a new study published Sept. 17 in AJOB Empirical Bioethics.
Researchers from the University of Chicago and the University of California, San Francisco, found that women value clear information shared early with their health care providers to help them anticipate religious constraints before their care becomes urgent.
Jocelyn Wascher, MD, a gynecologist obstetrician from the University of Chicago, Dr. Debra Stulberg, chair of the UChicaga Department of Family Medicine, and UCSF medical sociologist Dr. Lori Freedman interviewed 33 women of reproductive age from the national sample. who sought care in a Catholic hospital. Most of the women identified themselves as Christian or Catholic, and were different geographically, age, racially, and ethnically. The women expressed respect for the religious beliefs of the doctors and hospital administrators, but sought to balance this by valuing personal autonomy and decision-making.
One woman the researchers spoke to needed a cesarean section and wanted to connect the tubes at the same time. However, she was told on the day of her C-cut that the hospital was not doing fallopian tube ligation because of her religious beliefs. She told the researchers, “When you go to the hospital, you want them to do what you want. You should be in charge of your medical care, not their beliefs.”
Other women in the study share that view, adding that patients should research hospital policies and affiliations before choosing where to receive care. However, they also wanted the hospital to do more to inform them.
A woman who was banned from tying her fallopian tubes during her C-cut said she was upset that the hospital had not previously told her about their rules. “I also think they could have told me that even before the day of my C-cut,” the woman said.
Another interlocutor told researchers that religious care restrictions “should be pasted in 50-foot neon letters on the building’s front door,” instead of something a woman learns in real time if she happens to have a helpful doctor.
The authors of the study pointed out that the American Medical Association advises physicians who have moral objections to certain services to disclose any objections before establishing a patient-physician relationship. They also recommend informing patients of all available treatment options and referring them to other providers if necessary. The authors recommend that health care institutions adhere to the same ethical standards.
“I have cared for a number of patients who have been denied the desired reproductive health care because of the religion of the hospital where they accidentally showed up,” said Stulberg, who ended up in a hospital that switched from secular to Catholic during her stay.
Stulberg has seen patients rapidly lose access to contraception and pregnancy-related care. She was stimulated by an interest in the subject and led to continue her ethical training through UChicag’s MacLean Center for Clinical Medical Ethics before joining college. Today, this is her primary focus of research.
Wascher, the first author of the article, decided to be OB-GYN to provide comprehensive care for pregnancy and reproductive health. “It’s hard to imagine sitting with a patient who wants to and who would benefit medically from my care, and then I have to tell her,‘ I’m sorry, we can’t do this here. ’It would break my heart,” she said.
The study, entitled “Limitations of Reproductive Care in Catholic Hospitals: A Qualitative Study of Patient Experiences and Perspectives,” was supported by the Family Planning Society Research Fund.
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