N

ot that long ago, there was little difference between a physician and a preacher, a clinic and a chapel, a patient and a proselyte. Instead of prescribing medications, healers chanted hymns; instead of prescribing painkillers, they offered prayers.

Faith remains an integral part of human society and the modern hospital is a place where patients and physicians of all faiths work together. I am a Muslim physician who trained at a Boston hospital formed because none of the other local hospitals would offer Jewish doctors a job. On any given day, I see patients from myriad faiths, not to mention cultural backgrounds and sexual orientations.

I worry that the Trump administration is turning back the clock to a time when religious beliefs were used to deny patients medical care. Attorney General Jeff Sessions announced the formation of a “Religious Liberty Task Force” that directs federal agencies to give individuals and organizations great freedom to act — or refuse action — if they believe it impinges on their freedom of religious expression. This builds on the Department of Health and Human Services creating a Conscience and Religious Freedom Division, making it easier for doctors and nurses to refuse to treat patients based on religious or cultural objections.

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The scope of such refusals can span the spectrum of life, from issues related to contraception, abortion, and childbirth to care at the end of life. These refusals can also include rejection of care to LGBT patients.

The administration’s efforts to allow doctors and nurses to deny patients medical care based on their own personal beliefs would be furthered in the appointment of Brett Kavanaugh to the Supreme Court. Hailed in the National Review as a “warrior for religious liberty,” many conservatives hope that Kavanaugh will aid the culture wars the Trump administration is waging across the country, from bathrooms to bakeries.

As the administration extends this religious liberty crusade to health care and hospitals, where Americans are most vulnerable, Kavanaugh’s record suggests that he could help move this agenda forward.

Kavanaugh’s support for religiously motivated conscientious objections are best laid out in his dissent in the Priests for Life vs. HHS case. In 2012, the non-profit group Priests for Life sued the U.S. Department of Health and Human Services over a requirement in the Affordable Care Act that required employers to cover the cost of contraception and abortion-inducing medications. While the District of Columbia Circuit ruled in favor of the government, Kavanaugh dissented.

He wrote, “The essential principle is crystal clear: When the Government forces someone to take an action contrary to his or her sincere religious belief…the Government has substantially burdened the individual’s exercise of religion.” He went on to say that “judges may not question the correctness of a plaintiff’s religious beliefs.”

The American hospital aspires to be a sacred place where people of every creed, color, sexual orientation, and religious belief, can come to and receive care without fear of judgment and prejudice.

That is, of course, easier said than done. Physicians and nurses are human and are not immune to feeling conflicted when managing patients of different faiths. Several years ago, I was assigned to take care of a patient who came to the emergency department vomiting blood. He had been drinking heavily for years; his cirrhotic liver was failing and was unable to clear his body of toxins. His blood level was dangerously low but he wouldn’t let us give him a blood transfusion, since that was against his religious beliefs.

I felt torn about not being able to do what I felt was right for him and felt worse for his children who I worried might be left fatherless if we weren’t able to save him. Yet I also understood that I was there to provide care for him as a whole person, which meant figuring out how we could manage his profound blood loss within the bounds of his belief. And we did.

Like their non-physician counterparts, almost nine in 10 American physicians are affiliated with a religion. Unlike their patients, though, doctors are more likely to consider themselves spiritual rather than religious. Doctors’ religiosity certainly affects how they go about managing patients: doctors who are more religious are more likely to be opposed to withdrawing life support from their patients. Patients who are taken care of by more religious doctors tend to die sooner after being withdrawn from life support, suggesting that the decision to remove supports such as mechanical ventilation had been delayed until the patient was very close to dying.

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Patients should not have to worry that their physicians’ or nurses’ religious beliefs supersede their duty to provide unbiased care. In fact, patients’ right to receive care congruent with their religious or spiritual beliefs is recognized by governing bodies like the World Health Organization. If anything, doctors are undertrained in being able to address the need for many patients to discuss religious and spiritual issues, especially when they are dealing with serious illness.

Practicing medicine can take health care providers outside of their comfort zones. Sometimes that means holding hands and saying a prayer in a foreign language. Sometimes it means making choices on behalf of patients one wouldn’t necessarily make for themselves or their own family members. Sometimes it might mean working outside the confines of a belief they hold dearly.

In such moments, I silently recite one of the laws of medicine made famous in “The House of God,” a satirical 1978 novel: “the patient is the one with the disease.” While being a doctor and nurse can be challenging, it comes nowhere close to what patients experience. While it is important for medical providers to focus on their own selves, they must remember that patients come first, and that they are the ones who need to be supported as best as possible.

When I enter a patient’s room in the hospital and reach for the dispenser of antibacterial gel, I try to leave my values and beliefs at the door. Health care providers and the organizations that represent them should fight for an ecosystem in which patients receive equitable care regardless of their religious and spiritual belief. Doctors and nurses need to ensure that they deliver medical care without discriminating against the patients who walk in to their hospitals or clinics and should resist the administration’s efforts to turn back the clock.

Haider Warraich, M.D., is a fellow in cardiology at Duke University Medical Center and the author of “Modern Death: How Medicine Changed the End of Life” (St. Martin’s Press). The views expressed in this article are those of the author and do not necessarily reflect those of his employer.

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  • With all respect to the “beliefs” of others I have this to say. Socialism is here! Christians do not force themselves on others like many other different groups and religious/non-religious groups. How quick one is to put down religion as the evil doer! Religion is a Freedom for all not to be picked apart because of particular beliefs, political preferences etc. Please tell me this. How are things doing these days WITHOUT God in our lives. The corruption in all aspects today affects everything! Government, business, health care systems, pharmaceutical companies. Don’t put religion to the forefront as though it’s the reason for the greed in this fallen society. No disrespect intended. God bless!

    • Carol, the people who spout religiosity appear to be the most corrupt. Christians very often force their beliefs on others, isolate and demean family members and others that do not attend the same church, and even deny healthcare to people because of their lack of faith. Perhaps yous should read some history books about the Inquisition, and the Reformation, when Christians tortured each other to death. There are even museum exhibits that contain the actual torture devices.
      I know a lot of people who attend cult like churches that exist only to frighten people and take their money. These predatory churches have no qualms about taking from vulnerable frightened people. We only have to look at the hypocrites not running our government, who proclaim their faith at every opportunity, while committing crimes, and promoting racism, and hate.
      Christianity no longer has anything to do with Christ, it seems to be the opposite of when he represents. The only time J.C. got angry was with the money lenders at the temple, yet that , mean that is almost never discussed in church. Our Founding Fathers saw the barbarity and horror caused by Faith, that is why they insisted on Separation of church and state. The results of forcing taxpayers to support religion are already causing deaths despair and disease across the US. I guess you never noticed that religious hospital are almost always more expensive and more dangerous that the for profit versions.

  • One in six hospital beds in the US is now in a religious hospital. The false assumption that a religious non profit would provide better or less expensive care, underlies their expansion. No effort was made to calculate how this was affecting patients, policies, or healthcare outcomes. The costs are comparable to for profit providers, but that Fact does not register.
    The current lies and deception about healthcare, are based on not collecting data, because healthcare lobbyists told Congress the facts and data were “government overreach.”
    Hospitals and other healthcare providers are immensely powerful, they leverage the obscene amounts of money they control, into careful and strategic propaganda. They own local newspapers, meaning that no negative content will be run. They created their own quality assessment organizations, to spout meaningless numbers. Carefully worded Customer Service Surveys are designed to mislead the public and avoid accountability.

    Well established biases, are so systemic, they are not discussed. These religious corporations also bought up local medical practices, creating monopolies in some areas. They contributed a lot of money to local political campaigns, so no one challenged any of this. These corporations have institutionalized deceit, lies and deliberate misdiagnosis, for the people whose ‘Lifestyles’ they do not approve of. The resulting damage is not calculated, or counted. They can deny care, postpone it, and there is no way to quantify any of this, since they own local newspapers and politicians. Religious zealots do not approve of unmarried women, gays, minorities, and any irrational thing the bible can justify. There is no way to calculate, other than the suicide rates, infant maternal death rates, and levels of despair. These religious corporations are at the same time draining the resources of the faithful, as they lose their homes, due to medical bills. Communities remain silent, because profits are now a part of the old “Faith Based Initiative.”
    We are in Post fact America, where religious monopolies own huge segments of the healthcare industry, and their “excess capital” does not go to shareholders, but into acquiring even more providers. While they do take private insurance a major source of their profits are from Medicare and Medicaid, meaning the Taxpayers or the American public are paying to support in some cases religious extremism. The people injured, killed or forced into despair and hopelessness by their local healthcare provider have been shut down and silenced. The really clever bean counters, figured out how to turn a profit on religious “Freedom.” They are free to discriminate against anyone they believe is not of their faith. They openly endorse torture, unnecessary medical interventions, even as the communities they are bleeding dry, show the damage. There is no data collected anymore, especially that might show whether an expensive “Misdiagnosis” was due to a patients gender identity or marital status. Thanks to religion, they can justify every death, iatrogenic injury, or long term disability, as “God’ Will.” These out of control corporation prey on the faithful too.

  • To examine the story of the patient refusing a blood transfusion because of religious grounds, I would examine from another view point.
    What if the health care provider refuses to administer blood transfusions because of their religious beliefs? Would the hospital be forced to keep this person employed?

  • You make a great point about Kavanaugh. Unfortunately, the larger underlying issue is religion, and educated people like yourself and Kavanaugh, still entrenched in these “belief” systems. I understand the brainwashing mechanism religion uses on kids to keep the continuation of the cult going. But educated adults making life changing decisions should know fact from fairy tale. If not, religion becomes justification for bigotry and basis for policy.

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