END OF LIFE CARE
Doctors face clinical ethical conflicts where end of life care is restricted. 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 their patients in those facilities, where end-of-life care, abortion and other practices may be restricted.
"Religious hospitals represent nearly 20 percent of our health care system," said Dr. Debra Stulberg, author of the new study and instructor of family medicine and obstetrics and gynecology at the University of Chicago.
"Yet we know little about how religious policy affects the care doctors give to patients. This study is the first to systematically ask physicians whether religious hospital policies conflict with their judgment. We found that for a significant number of physicians they do."
The researchers surveyed 446 family physicians, general internists and general practitioners about their experiences. Forty-three percent had worked in a religiously affiliated hospital, and of that number, 19 percent said they had "some" conflict with the institution's patient care policies.
"Primary care physicians routinely see patients facing reproductive health or end-of-life decisions that may be restricted in religious health care institutions, so we were not surprised to learn that nearly one in five of the physicians who have worked in a religious setting have faced a conflict with their hospital," Dr. Stulberg said.
The survey was specific: What should a physician do if a patient needed an intervention the hospital barred due to its religious practices?
The doctors were also asked to weigh in on four ethical scenarios. Should they provide an intervention openly whatever the risk, or intervene discreetly to avoid getting fired or losing their privileges at the facility? Alternatively, should doctors encourage the patient to go to another hospital or recommend another treatment approved by the religious hospital?
Almost all of the respondents — 96 percent — agreed that physicians "should adhere" to hospital policy. But 86 percent also thought a doctor facing conflict with religious policies should refer the patient to another hospital. Only 10 percent thought recommending another treatment approved by the hospital was a good idea, while 4 percent supported acting, either openly or discreetly, against hospital policy.
Responses showed that 43 percent of primary care physicians have practiced in a religiously affiliated setting. Of these, 19 percent experienced conflict with religious policies.
Those policies can be succinct, and philosophical as well.
"Our ministry is an enduring sign of health care rooted in our belief that every person is a treasure, every life a sacred gift, every human being a unity of body, mind and spirit. We work to bring alive the Gospel vision of justice and peace," notes a statement of the District-based Catholic Health Care Association, which tracks the 620 Catholic hospitals and 61 Catholic heath care systems in all 50 states.
"We answer Gods call to foster healing, act with compassion and promote wellness for all persons and communities, with special attention to our neighbors who are poor, underserved and most vulnerable. By our service, we strive to transform hurt into hope."