Fulfilling Oaths and Following Conscience: Catholic Hospitals

The ability of Catholic hospitals and physicians to withhold some medically accepted care from patients based on their own religious and moral beliefs is made possible by numerous protections of religious freedoms. However, patients look to their physicians as trusted partners in their care who will act solely in their best interest and include them in care decisions. These two realities come into conflict at both the individual and societal levels, and therefore, deserve discussion:

• The training of future physicians in Catholic healthcare.

• The responsibilities of physicians to their patients as dictated by their professional oaths.

• The intersection of these responsibilities with Catholic institutions’ mandate that physicians follow the ERDs.

• The breadth of the legal protection for Catholic hospitals and their physicians in the exercise of their religious beliefs.

IMPACT ON PHYSICIANS

Trainees

Patient care within the U.S. health system is directed by licensed professionals — frequently physicians. Often, they oversee and contribute to the training of medical students and physicians in their post-graduate years as interns, residents, and fellows. This training occurs in a hospital setting, including Catholic hospitals.

Two hundred eighty-one of the 550 Catholic hospitals are minor teaching hospitals and 14 are major teaching hospitals.(1) These institutions assume responsibility for providing all the post-graduate training needed for a person to be a competent physician. However, in Catholic hospitals, trainees are not exposed to any of the services prohibited by the ERDs, nor do they engage in shared decision making with their patients for these services. They may face moral dilemmas in withholding certain types of care. To obtain the required experience, trainees are often sent to other institutions for some periods of time.

The Accreditation Council for Graduate Medical Education (ACGME), the body that accredits all training programs in the United States, does not specifically identify which programs are in Catholic hospitals (personal communication Kathleen Quinn-Leering and John Combes ACGME).(2) However, the ACGME affirms that all the training programs in a specific discipline, including obstetrics and gynecology, have the same requirements.

The review committees that grant accreditation review the programs annually, examining case logs of the residents’ procedures, resident and faculty annual surveys, annual program updates, and percent of residents passing the board examinations, which has a threshold of 80% (personal communication Kathleen Quinn-leering and John Combes, ACGME).

Despite this extensive information about the training program and trainees, it is not clear that adequate clinical training occurs. A small interview study of obstetricians and gynecologists practicing in secular institutions who had completed residency at a Catholic hospital one to five years previously revealed that “none of the interviewees felt their program provided sufficient off-site training in all areas of family planning to compensate for the lack of these elements in their regular curriculum and experiences.”3 They also reported that when they entered practice, they needed a variety of strategies to compensate for this gap.(3)

In the 1990s, (personal communication, John Combes, ACGME) the ACGME took legal action against a program at a Catholic hospital for failure to comply with the requirements, but there have been no similar actions since then. However, other actions may have been taken against training programs.

References

1. American Hospital Association. Hospital Operational and Demographic Data: FY 2020 AHA Annual Survey Database. Chicago: American Hospital Association. www.ahadata.com.

2. Accreditation Council for Graduate Medical Education (ACGME). https://www.acgme.org.

3. Guiahi M, Hoover J, Swartz M, Teal S. Impact of Catholic Hospital Affiliation During Obstetrics and Gynecology Residency on the Provision of Family Planning. Journal of Graduate Medical Education. 2017;9(4):440–446.

Excerpted from The Catholic Church and Its Hospitals: A Marriage Made in Heaven? (American Association for Physician Leadership, 2023).