Research & other work 
Health care refusals
Health care refusalsHealth Care Refusals Projects
Health Care Refusals: Undermining the Medical Standard of Care for Women | DHHS Regulations Discourse Analysis | “When There’s a Heartbeat: Miscarriage Management in Catholic-owned Hospitals” | The Effect of Hospital Mergers on Access to Reproductive Health Care
Institutions that impose ideological restrictions on health care delivery have assumed increasing control of hospitals and managed care systems in the United States. These organizations often impose limitations on the health care the clinicians in their system can provide. At the same time, broad statutory refusal clauses allowing health care personnel to refuse to provide critical information and services based on their personal beliefs also are proliferating. To date there has been no rigorous analysis examining the extent to which denials of care affect the overall health of women, particularly low-income women whose choice of health providers is often limited. ANSIRH is currently involved in several projects seeking to fill this knowledge gap.
Health Care Refusals: Undermining the Medical Standard of Care for Women is a collaborative project with the National Health Law Program (NHeLP). This project investigates and documents whether and to what extent these denials conflict with professionally developed, accepted medical standards of care, and analyzes the potential health consequences to patients. This analysis provides a new framework for evaluating refusal clauses and denials of care, hospital mergers, and other transactions when they conflict with accepted and expected medical practice.
The project team has compiled a report that provides background and analysis of the ethical and legal concepts of standards of care and informed consent, and then analyzes religious, ideological and political restrictions and denials of care that conflict with and undermine established medical standards. It also provides detailed descriptions and analysis of the standards of care that govern medical practice for a range of common health conditions and illustrates how refusals and denials of care violate those standards and put women’s health at risk.
DHHS Regulations Discourse Analysis: Policing the line between abortion and contraception is a textual analysis of the thousands of responses submitted to the federal government in response to the issuing of a new Department of Health regulation expanding protection for health care refusals. The site of inquiry for this project is the distinction between abortion and contraception and the extent to which allowance of refusals to provide abortion care are seen as different from allowances to refuse to provide contraceptive services.
“When There’s a Heartbeat: Miscarriage Management in Catholic-owned Hospitals.” During the course of conducting dissertation research on obstetrics and gynecology training and practice, Dr. Lori Freedman conducted physician interviews which revealed that miscarriages are managed differently in Catholic hospitals when the fetal heartbeat is still detectable. Some physicians expressed frustration when their ethics committee would not approve uterine evacuation in these cases because the Directives equated it with abortion, even when miscarriage was inevitable. Therefore doctors reported transporting their patients to non-Catholic facilities or waiting for the patient to become infected and sick enough to compromise her life, at which point the ethics committee would approve the intervention. These findings were published in American Journal of Public Health in October 2008 and motivated Dr. Freedman to further investigate the impact of Catholic health care on patients.
The Effect of Hospital Mergers on Access to Reproductive Health Care is a project under development by Drs. Tracy Weitz and Lori Freedman. This two-part study proposes to 1) document the history, prevalence, and circumstances of Catholic-owned hospital mergers in California and 2) conduct an in-depth case study of the specific impact on access to reproductive health care as the outcome of one such merger in Gilroy, California.
To date, there has been no rigorous analysis examining the extent to which denials of care affect the overall health of women. ANSIRH is currently involved in several projects seeking to fill this knowledge gap.
Photo courtesy of Elias Friedman, through Wikimedia Commons.