Access to Health Care Should Not Be Limited by Religious Doctrine

Tuesday, August 27, 2013

This was published as a guest opinion in the Puget Sound Business Journal of Aug. 16.

The health care market in Washington looks very different today than it did a few years ago, and the pace of change will only accelerate as the Affordable Care Act – aka Obamacare – is implemented. One notable phenomenon is a spate of mergers, often involving religious health care corporations taking control of secular health institutions.  Indeed, if all proposed mergers go through this year, nearly half of all hospital beds in Washington will be in religiously affiliated facilities.

And one result of these mergers is of great concern to civil libertarians: The restriction of health care services based on religious doctrine.

The ACLU does not object to hospital mergers per se, but believes that no patient should be refused access to lawful health care because of the religious ideology of the institutions running hospitals, clinics, or other medical facilities. Consumers should be able to access medical services in their local communities consistent with medical best practices and patient needs.

A hospital’s religious affiliation may impact patients’ access to important health care services. Catholic-affiliated hospitals follow the Ethical and Religious Directives for Catholic Health Care Services of the U.S. Conference of Catholic Bishops, which require hospitals to refuse to provide care that conflicts with the moral teachings of the Catholic Church. These include birth control, fertility treatments, and other reproductive health services; end-of-life directives; and medical services for LGBT patients.

The restrictions conflict with Washington’s public policy and law, which has historically protected access to services:

  • The Reproductive Privacy Act, enacted by voters in 1991, establishes as public policy of the state of Washington that “every individual has the fundamental right to choose or refuse birth control,” and “every woman has the fundamental right to choose or refuse to have an abortion.”
  • The Anderson Murray Anti-Discrimination Law, passed by the legislature in 2006, prohibits discrimination based on sexual orientation and gender expression or identity; it includes discrimination by providers of medical services.
  • The Death with Dignity Act, enacted by voters in 2008, allows terminally ill adults to request lethal doses of medication from medical and osteopathic physicians.

Hospitals tied to religious institutions already play a major role in our health care system.  It is estimated that 30-37% of hospital admissions statewide are to religiously affiliated hospitals, and 40% of hospital beds are in religiously affiliated hospitals. In certain areas of Washington, the only hospitals or health care facilities serving the public are religiously affiliated.

Now, merger proposals are pending for a Bremerton hospital serving four counties and for three hospitals serving Snohomish and Skagit Counties. In Seattle, a merger with religiously affiliated Providence Hospital led secular Swedish Hospital to stop providing elective abortions.

When mergers happen, state and local officials must act to protect patient access to health care. As PSBJ reported (July 3), Governor Inslee has directed the Department of Health to update the state’s rules for approving hospital mergers. This is a needed first step, but much more needs to be done.

For employers, concerns about religious restrictions are far from academic. Ensuring comprehensive health care services in the community is part of attracting and retaining the best workers.  Just as they want good schools for their children in the community, employees want access to all lawful health services in the community, and shouldn’t have to travel outside of the community to obtain needed care.

Employers should seek full disclosure about which services health care providers do and do not provide and should make this information available to employees. Patients need to be able to make fully informed decisions about their health care options.