The crusade for ‘religious liberty’ will reverberate badly in health care

Not 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.

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.

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.