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Richard P. Sloan

When religion and health care collide

The California Supreme Court recently ruled against two physicians who allegedly denied — based on their religious opposition — a legal medical treatment to a patient based on her sexual orientation. The decision was issued in a lawsuit filed by a lesbian against doctors in a Vista, Calif., medical group who refused to artificially inseminate her.

This is a welcome, if unusual, turnabout in a disturbing trend that has characterized U.S. medicine over the past three decades: an increasing willingness to allow the actions of individuals to disadvantage, and even endanger, others if those actions derive from religious faith.

Almost every state has legislation permitting health care professionals — from physicians to nurses to pharmacists — to deny patients legal medical treatments that they might find religiously objectionable. At the federal level, the Bush administration recently announced plans to implement a regulation that would deny federal funds to hospitals, health plans and other entities that do not permit their employees to opt out of participating in legal medical procedures — including those associated with reproduction and terminal sedation — that they oppose out of religious conviction.

This summer, a "pharmacy for life" was set to open in the suburbs of Washington, D.C. Like other similar pharmacies, it won't stock condoms, contraceptives or the so-called morning-after contraceptive Plan B, despite the fact that pharmacies are licensed by state governments giving them the exclusive right to dispense medications. In exchange for these monopoly rights, pharmacists have an ethical obligation to act in the interests of patients.

Recent studies have shown that 14 percent of U.S. doctors, when confronted by possibly objectionable but legal medical treatments, not only would refuse to deliver such care but also would refuse to inform their patients about it or refer them to physicians who would deliver the care. That translates to about 40-million people who would receive substandard care from these physicians, who believe that their religious convictions are more important than the well-being of their patients.

The tradition of religious freedom in the United States is one of the founding ideals of this country. But as our framers envisioned it, religious freedom referred to a right to practice one's own religion free of interference from others. It did not refer to religiously based interference with the rights of others, who might have their own and different religious traditions. Even in the relatively religiously homogeneous era of the framers, such interference was not acceptable. It is even less so in 21st-century America. With religious heterogeneity growing, the devotional demands of one group might be increasingly at odds with those of others.

Yet too often, our deference to religion in contemporary American society has allowed us to subordinate all other values. It has allowed us to accept religiously motivated behaviors that we otherwise would have no reluctance to sanction and that, indeed, would be impermissible with any other justification.

So it's time to say "enough." In the United States, we all are free to practice our religion as we see fit, as long as we do not interfere with the well-being of others by imposing our religious views on them. If physicians or other health care providers who have religious objections to legal medical treatments will not at a minimum inform their patients about those treatments and refer them to others who will deliver them, they should act in a way that is consistent with their convictions and the well-being of their patients and find other professions.

Freedom of religion is a cherished value in American society. So is the right to be free of religious domination by others.

Richard Sloan is a professor of behavioral medicine at Columbia University Medical Center.

When religion and health care collide 09/01/08 [Last modified: Tuesday, September 2, 2008 4:06pm]
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