Crisis of Conscience: Reconciling Religious Health Care Providers' Beliefs and Patients' Rights

By White, Katherine A. | Stanford Law Review, July 1999 | Go to article overview
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Crisis of Conscience: Reconciling Religious Health Care Providers' Beliefs and Patients' Rights


White, Katherine A., Stanford Law Review


In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to "sensitive" services like abortion, family planning, HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers' right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White's analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients' right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal "bypass" legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.

INTRODUCTION

Religious health care facilities and networks form the largest category of nonprofit providers of health care in the United States.(1) While many different denominations participate in providing health care to the public, Roman Catholic institutions play an especially significant role. Catholic health care organizations combined control more than twice the market controlled by Columbia/HCA, the largest commercial health care entity.(2) Many of the 600 Catholic hospitals in the United States have large networks of health care providers affiliated with them.(3) As religious health networks expand their services to offer managed care services to the public and to Medicaid recipients, providers' religious beliefs will increasingly influence patient access to services. The Catholic Church manages its health care organizations according to the Ethical and Religious Directives for Catholic Health Care Services, which define church opposition to abortion, sterilization, family planning, the morning after pill, HIV counseling that includes information about condom use, infertility treatments, and termination of life-support.(4)

In conflict with the Catholic directives, various state and federal laws require health care providers to make "sensitive" services available. For instance, the federal Medicaid statute specifies that recipients shall have access to family planning services.(5) Some state laws require private insurers to cover contraceptive services, and others require hospitals to provide rape victims with information about the morning after pill. Courts have differed when asked to resolve conflicts between providers' beliefs and patients' legal rights to determine medical treatment decisions. In Part II, I will discuss these "sensitive" services, religious teachings regarding them, statutes protecting religious providers' objections, and case law considering patients' rights.

The United States Constitution offers little clear guidance for resolving these conflicts, since both the Free Exercise Clause and the Establishment Clause of the First Amendment influence whether state accommodation of religious beliefs is mandated, prohibited, or merely permitted. Patients also have constitutionally protected rights to control reproductive decisions in some circumstances.

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