Protecting a Patient’s Right to Know

If you’ve seen me talk about Catholic health care in the U.S. before, you know that there are a number of things that piss me off. You also know that one of the top items on this list is that Catholic health services prevent patients from making informed choices about their health or giving informed consent to their health care providers.

Not only do these facilities maintain a list of directives where they will substitute their “moral” judgment for evidence-based standards of care, but they won’t tell you that they do so. They won’t disclose all your treatment options, and they won’t tell you when a safer option than the one they’re recommending exists. They have decided in all their heavenly wisdom that it is better to keep you in the dark than run the risk that you’ll seek these treatments elsewhere.

American Atheists has just made me very happy by announcing a plan to change that.

“This is about disclosure, not about forcing providers to do anything they have a religious objection to. If a religiously affiliated hospital or health care provider has some objection to providing birth control, access to cancer therapies that could result in sterilization, mental health services, or hormone replacement therapy, they can continue to opt out of providing those services. What they can’t do is pull a bait and switch on patients and potential patients,” added Knief.

The proposed legislation would require health care providers to simply provide a list of services they will not perform for religious reason to patients, potential patients, health insurers, and state and federal grant or subsidy programs. The health care providers and insurance issuers would then be required to make that information available online for potential patients.

American Atheists will work with its 170+ local affiliates and coalition partners to build support for this legislation in both Congress and the 50 states.

This is the kind of thing I was hoping for when Amanda Knief moved into a policy position in the American Atheists reorganization, and I’m fiercely happy to see it. The proposed legislation (pdf), which she drafted after consulting with stakeholders across the country contains five provisions to ensure that people interested in receiving or funding the best health care will be presented with a list of religious limitations on health care in a timely fashion.

  • Patients or their proxies will be informed as soon as they can agree to be treated.
  • Those shopping for a doctor or health care system online will see the list prominently displayed.
  • Employers and health insurance companies will provide the lists to their enrolleees.
  • Government licensing agencies and agencies that fund health care will be informed.
  • Governmental grant-making agencies that fund specific health care initiatives will be informed.

This is in the early stages yet. I’ll try to make sure I see and pass along any requests from American Atheists that will help make this a reality. You can also talk to your local group if they’re an American Atheists affiliate (like Minnesota Atheists) and let them know you want to help on this.

In the meantime, you can work on educating people around you about the problem, which lots of folks still don’t know exists. This is an issue that affects far more than atheists, making it a great opportunity for people who enjoy partnering with progressive religious groups. It’s also something feminist organizations should be interested in. There will be plenty of opportunities to bring people together over this.

This bill won’t solve this problem all by itself, but it will help create demand for solutions. I hope to see it pass and soon.

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Protecting a Patient’s Right to Know
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7 thoughts on “Protecting a Patient’s Right to Know

  1. 1

    This is awesome. The first thing that would happen is that the public would be horrified to find out they hadn’t been informed of all their options. And the second is that insurance companies would look for a way out of being liable to pay for worse outcomes from institutions that follow the Directives.

    There’s a lot of ways that second step could happen. Insurance companies could classify Catholic institutions as non-preferred, meaning ambulance traffic would be treat them as the institution of last resort and patients would go anywhere else that’s an option. Or insurance companies could require policies that subordinate religious requirements to patient care (and probably cost). This would force Catholic institutions to either renegotiate their relationship with the church or accept being moved off to the side of the health care marketplace. Either one works for me.

  2. 2

    It’s a great start.

    In areas where Catholic health care is the only option for miles it will, of course, only go so far.
    But maybe it would give those who should be regulating Catholic buy-outs of healthcare, hospitals, clinics, etc, more political will to do better.

    IOW, yes in areas where there are actually options besides the Catholic-run institutions, the scenarios laid out in #1 would work fine. The problem is the many, many areas/regions where there are NOT other options. And those areas/regions are becoming more numerous and extensive all the time.

  3. 3

    Yes, those institutions wouldn’t feel pressure from the public voting with their feet because the only hospital in the county is already a local monopoly.

    I suppose it’s possible that insurance companies would start really digging into the data on outcomes and act to limit their exposure to the worst ones, but their leverage is far more limited in monopoly markets. I don’t think there’s any way to solve this while hospitals are giving deference to the Directives. I have the impression that Catholic-affiliated hospitals don’t get much operating funds from the church. If that’s true, then even a small threat to the hospital’s income stream could be enough to force a change in behavior. But I don’t have the data that shows it.

  4. 4

    As noted above, it may be a politically useful first step, but with only a few modifications we have:

    The proposed legislation would require lunch providers to simply provide a list of ethnicities and religions they will not serve for religious reasons to customers, potential customers, and state and federal welfare programs. The welfare programs would then be required to make that information available online for potential customers.

  5. 6

    Sounds like a lot bigger burden on the Catholics than the Little Sisters of the Poor are fighting all the way to the Supreme Court. In both cases the Catholics are objecting to informing others of their religious objections, but in the case currently being litigated they only have to send one letter, where here they have to post stuff all over the place and actively inform nearly every patient and member of the chain of care.

    Good idea, but it’s going to be very, very expensive to litigate.

  6. 7

    This is very personal to me.

    When I was a young mother, with a three year old son that was the light of my life, I found that caring for him all day could get a little boring. So I started reading my husband’s medical school text books. I know, but I did say I was bored.
    In his obstetrics book I ran across this sentence: “A doctor who does not rule out ectopic pregnancy for any sexually active woman presenting with abdominal pain is guilty of malpractice.”

    Flat statement. Nothing even remotely like that was in any other text book.

    I sat there and stared at that for a long time. It put together some things that had been bothering me for several years. When I read that I realized I had survived an attempt to murder me.

    You see, a few years before I went to a hospital emergency room complaining of excruciating pain in my abdomen that had been happening off and on for about three days, interspersed with a low aching pain in my lower left quadrant and recent nausea and vomiting. I was admitted, the doctor examined me and when he asked about my periods I mentioned that my period was a few days late and the period before that had been very light, just a few spots really. He gave me what I now know was a HUGE dose of demerol, and in the morning told me I had “viral enteritis” (what we usually call stomach flu). I believed him. I was young and innocent. At the time, I had never even heard of ectopic pregnancy. The fact that it was a Catholic hospital never pinged my radar.

    About 18 hours later my husband helped me get to a hospital in a small town in the wilds of central Wisconsin at 2 in the morning. My blood pressure was 60/40 at that time. They loaded me up on as much blood and other fluids as they could in about 4 hours and did a pregnancy test (at the time pregnancy tests were not available over the counter). I was pregnant. The doctor did the surgery, but I had been in the process of bleeding out from a ruptured fallopian tube and was in no condition for surgery. My heart stopped twice on the table. If I had not been 19 and in excellent health I would not have survived. He removed my fallopian tube with “the products of conception” or, as some would say, “an innocent child”, and saved my life.

    If that doctor at the Catholic hospital had done his job two things would have happened: 1) I would have had a relatively easy surgery with most of my blood still in my veins and the surgeon able to work without me trying to die so enthusiastically; and 2) that doctor would have lost his admitting and surgical privileges at that hospital. That would probably have cost him at least half his income. He let me leave that hospital, not telling me that I probably had a time bomb ticking in my belly. As far as I am concerned he attempted to murder me. Depraved indifference to human life resulting in death is murder. For his “principles” or for money, it doesn’t really make any difference. And, yeah, I am still pissed about it.

    Later on I learned that terfing patients with a probable ectopic pregnancy WITHOUT TELLING THEM was SOP at Catholic hospitals. It still is.

    So every time I hear someone talk about a “right to life” I have to control my impulse to spit in their faces. They don’t really give a single damn about a “right to life”. They don’t care about “innocent children”. They sure as hell don’t care about the well-being of women. Any attempt to put a stop to what they do is good as far as I am concerned.

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