There is an excellent article over at Science-based Medicine well worth reading. It’s about how the policies of religious-based hospitals affect physician behaviour, from which I have taken excerpts:
Science-based medicine is, among other things, a tool. Science helps us sequester our biases so that we may better understand reality. Of course, there is no way to avoid being human; our biases and our intuition still betray us, and when they do, we use other tools. Ethics help us think through situations using an explicitly-stated set of values…
And like all professions, these ethical values are spelled out so that each member of that profession adheres to the same ethical rules of conduct. Or, at least, that’s the intention….
Ethical problems are a normal part of medical practice. But ethics are not a weapon used to obtain a result we want; they are a tool to give a framework for understanding and resolving dilemmas. Ethical dilemmas can arise out of may types of conflicts, for example when our personal beliefs clash with those of our patients, or when patients’ and families’ desires conflict. They can also arise when we as physicians are constrained in our actions by outside forces.
And what might be an example of an ‘outside force’ be? If a government asked a physician to intentionally cause harm to one patient for information that could achieve a greater good for many, should a doctor do so?
I would object on the basis of many of these shared ethics: it violates patient autonomy, it causes them harm, and fails to benefit them. My responsibility to avoid harming my patient trumps my government’s desire to obtain information via torture.
What about providing appropriate science-based medical advice for something more controversial… like abortion?
There is no set of data that says that “abortion is harmful to women”, so doctors who oppose abortion cannot claim that science supports their bias. But if a doctor legitimately felt that a particular abortion would bring physical harm to a particular woman, then they must give her the advice they feel is necessary. Conversely, if a doctor feels that a particular abortion may help a particular patient, they must tell the patient.
I can see why the emphasis on following a standardized set of ethical guidelines is so important for professionals to frame controversial issues. And this raise a significant question when 20% of American hospital beds are religiously-affiliated: how does this affect the care given by doctors working with these institutions?
Well as luck would have it, a study has been released on just this question in the Journal of General Internal Medicine . For more specific data, please go the article’s link.
From an ethical perspective, these data are mixed. It is comforting that the polled doctors were more often willing to make decisions based on their patients’ needs rather than institutional policies, but it is disturbing that such significant barriers to care arise from these policies.
So which should prevail: hospital policies or medical ethics? As the article’s author concludes,
I find the intrusion of sectarian values into health care disturbing, especially since most of these institutions take money from federally-funded programs such as Medicare and Medicaid. At the same time, many of these institutions provide significant amounts of charitable care. I do not believe, however, that this creates a balance. Charity is good, but treating human beings with dignity and allowing for the science-based delivery of medical care should be a minimum requirement.
I would add that medical ethics need to be dominant over religiously inspired policies if we wish to publicly fund religious medical providers. If the religious institutions cannot agree to this hierarchy then they have no business accepting public money while pretending to provide science-based health care; instead, they should be clear that what care is provided will be religiously approved care and not ethical medicine.