Catholic Hospitals Should Improve Public Notification of Treatments They Conscientiously Refuse to Provide
Abram Brummett, PhD, HEC-C; Meaghan Race; and Randall Hilleary, Oakland University William Beaumont School of Medicine, Rochester, MN
In the United States, clinicians have a right to conscientiously object to provide services if doing so violates their moral or religious beliefs. Institutions also have a legally protected right to object on the same grounds. Importantly, it is Catholic institutions that most commonly invoke institutional conscientious objection. All Catholic health care organizations operate according to the Ethical and Religious Directives for Catholic Health Care Services (ERDs), which direct Catholic hospitals to refuse to provide such medical treatment as contraception, sterilization, and abortion. However, many persons in the United States are unaware of these regulations, and most Catholic hospitals fail to provide adequate advance notice of these restrictions. The right of institutional conscience comes with the responsibility of advance notification. Advance notification requires the reasonable attempt to inform patients of conscience restrictions prior to the clinical encounter. Although some jurisdictions have used legal measures to improve advance notification, we contend that upholding this responsibility serves the interests of Catholic hospitals in three ways.
First, the failure to provide adequate advance notification damages the trust between Catholic hospitals and patients because it undermines transparency in ways that can be disrespectful to patients and result in delayed care. Second, improving advance notification demonstrates a principled commitment to moral tolerance in a pluralistic society that is consistent with the ERDs and furthers Catholic interests. Third, improving advance notification practices prevents situations where clinicians who do not have a conscientious objection to the patient-requested medical care are faced with an ethical trilemma between falsifying the medical record, refusing the treatment while providing an ERD- prohibited referral, or refusing the treatment without providing a referral. Ultimately, advance notification prevents clinical encounters that damage trust with patients, delay care, and challenge the moral integrity of clinicians and show a principled commitment to the value of tolerance that is used to justify the legal conscience rights that Catholic clinicians and institutions receive. Our contentions should be of interest to clinicians who wish to advocate for improved advance notification practices at Catholic hospitals.
Importantly, we will consider objections to our view such as that it is too complicated of a message to communicate or that increasing advance notification should go both ways.
First, the failure to provide adequate advance notification damages the trust between Catholic hospitals and patients because it undermines transparency in ways that can be disrespectful to patients and result in delayed care. Second, improving advance notification demonstrates a principled commitment to moral tolerance in a pluralistic society that is consistent with the ERDs and furthers Catholic interests. Third, improving advance notification practices prevents situations where clinicians who do not have a conscientious objection to the patient-requested medical care are faced with an ethical trilemma between falsifying the medical record, refusing the treatment while providing an ERD- prohibited referral, or refusing the treatment without providing a referral. Ultimately, advance notification prevents clinical encounters that damage trust with patients, delay care, and challenge the moral integrity of clinicians and show a principled commitment to the value of tolerance that is used to justify the legal conscience rights that Catholic clinicians and institutions receive. Our contentions should be of interest to clinicians who wish to advocate for improved advance notification practices at Catholic hospitals.
Importantly, we will consider objections to our view such as that it is too complicated of a message to communicate or that increasing advance notification should go both ways.