|
 Services including sterilization, contraception and fertility
services can be similarly prohibited, according to the small study.
“One thing that did surprise me is that some hospitals really do
seem to leave women with little to no information when it comes to
abortion care specifically,” said lead author Dr. Debra Stulberg of
the University of Chicago. “For other services, whether it’s
something a Catholic hospital allows or not, they will facilitate
getting the appointment, sending records, etc.,” she told Reuters
Health.
“But I’m not speaking across the board for everyone, it wasn’t
always black and white,” Stulberg said.
Catholic healthcare institutions make up 15 percent of acute care
hospitals in the U.S., and clinicians employed in them are bound by
the Ethical and Religious Directives for Catholic Health Care
Services issued by the U.S. Conference of Catholic Bishops. These
directives prohibit some reproductive healthcare services, but some
Catholic theologians still believe doctors should openly explain all
options to their patients, even ones they are not able to provide.
Professional ethics guidelines from the American College of
Obstetricians and Gynecologists (ACOG) recommend that clinicians who
deny patients reproductive services for moral or religious reasons
provide a timely referral to prevent patient harm, but whether or
not physicians at Catholic facilities actually make these referrals
is unclear, the authors write in Perspectives on Sexual and
Reproductive Health.
For the study, a sociologist interviewed 27 practicing
obstetrician-gynecologists with experience working at a Catholic
hospital by phone, asking open-ended questions about how hospital
policy affected their patient care.
In some Catholic hospitals, administrators and ethicists allowed for
or even encouraged referrals to places like Planned Parenthood, but
in others, referral was actively discouraged, or doctors kept their
referral activity hidden.
“We talked to doctors with a range of opinions on abortion, some of
whom strongly expected to share the values of a Catholic hospital,”
Stulberg said. “Sometimes they were surprised because policies
changed” and attitudes toward referrals may depend on which bishops
issue new directives, she said.
In general, physicians said the Catholic ethical directives did not
always serve the best interests of women with limited financial
resources, those needing certain kinds of emergency care and those
who want to undergo sterilization by tubal ligation at the time of a
cesarean section or immediately after a vaginal delivery.
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“It concerns me as a doctor, from a standpoint of medical ethics,
ACOG says that when a healthcare provider can’t offer certain
services they have to provide full and accurate information,”
Stulberg said. “Even in some emergencies doctors couldn’t provide
care they thought the patient needed,” like giving high dose birth
control pills to control heavy bleeding, she said.
Some physicians said they got mixed messages from their hospital,
which may want to deny a service for moral reasons but want to
provide it for financial reasons.
In some cases, hospital policy relied on referring to other
facilities like Planned Parenthood, which was surprising, Stulberg
said.
“Some hospitals specifically said if there weren’t other places to
send these patients, then we might do (the procedures),” according
to the physician interviews, she said.
Many people may not have the option to choose between a Catholic or
secular healthcare facility, she said.
“For patients who have the same religious tradition, a catholic
hospital is perfect because she will only be given options she would
consider,” said Dr. Maura Quinlan, chair of the Illinois Section of
ACOG, who was not part of the study. “But it is not ethical to
decide that for the patient.”
Failing to refer women for reproductive care can have significant
negative effects on her health, Quinlan told Reuters Health by
email.
“Women should not assume that they’re getting all the information
that they may need to make an informed medical decision if they’re
going to a Catholic hospital,” Stulberg said. “It’s always good to
ask questions about your own medical situation, and unfortunately
you have to do some research beyond what you doctor can tell you.”
SOURCE: http://bit.ly/2ahrmhl Perspectives on Sexual and
Reproductive Health, online July 28, 2016.
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