Doctors’ religious choices cannot trump women’s health

Last week, I wrote an opinions column arguing that withholding women's reproductive health services is a form of violence (02.16.12, "Birth Control Ban Case of Violence Against Women"). The policy implication of this is obvious: Health care organizations should be required to provide these services. But this is much easier said than done. When we talk about women having access to medical services, when we say that these services are available, we need to consider how accurately this describes the behavior of medical providers and the experience of their patients.

Health care organizations can provide services in a number of different ways. They could provide the services in good spirits and under safe conditions, according to the optimal medical practices. If the services are something that the providers think is important—if it is something that they believe their patients need and deserve, and to which all people should have the human right to access— then we can expect that the institutions will provide the services appropriately.

On the other hand, if the institution morally disagrees with the service—if the providers judge the patients requesting the services to be morally objectionable, consider the requested medical interventions to be heretical and even homicidal—then how will they behave toward patients who come seeking these services? What nonverbal cues will convey their attitudes toward the patient? Which rooms in the hospital will be designated for these procedures?

Imagine a woman seeking internal contraception because her boyfriend refuses to wear a condom. She goes to the hospital and when she states the service that she is seeking, staff members express their opposition. She waits three hours before someone leads her down the hall to the acute psychiatric unit, to a room with no TV or magazines, and she waits there for two more hours. As you can see, hospitals can impose a number of barriers, disincentives and punishments for women seeking morally contested services. And because it is disguised as typical hospital inconvenience, political regulation of this behavior will be extremely difficult.

When the patient finally speaks to a doctor, how is the doctor going to convey their opinion about the moral status of the procedure, and of the person requesting the procedure? If this woman's doctor believes she is making decisions about her sex life behind her boyfriend's back, having sex out of wedlock, disobeying the law of the official religion of the institution that is now being forced to provide this service, then what can the woman expect her doctor to do? It would be naïve to think that these attitudes could ever be extracted from doctors' medical decisions. Even unconscious prejudice has been shown to predict biased medical behavior, as shown in a 2007 Harvard Medical School study. And in the case of attitudes toward women's reproductive health, we are probably not dealing with unconscious attitudes but with overtly antagonistic disapproval of patients.

The doctor can easily sabotage the patient's attempt to obtain birth control. They can prescribe an inappropriate dosage, recommend the option with the least effective action and most adverse side effects, or come up with some medical reason why the treatment would be unsafe for this particular patient. They can forego hand-washing or other safety measures. Or they can simply give misleading information about the various treatments while clearly communicating their disapproval of the patient's decisions. I would imagine that some patients would be so uncomfortable with this that they would leave the hospital. Then, if a pregnancy ensues, her inaction will be misread as an outcome of a decision that she made, when in reality she has been made a victim of systemic injustice that has been left unchecked by the government.

Appropriate treatment involves providing all of the relevant information, helping a patient navigate the dizzying array of treatment options, screening for abuse and assault, offering additional services, and carefully adhering to the treatment protocol. Ideology corrodes all of this. At any hospital, only a subset of medical staff can be trusted to provide reproductive medical services with full integrity. These staff members must be identified, and any other staff member must be regarded as a potential safety concern. It might even be a good idea to have the pro-reproductive rights staff members wear something (like a colored stripe on their lanyard) that will signal their identity to patients. Such a measure might go a long way in terms of sterilizing the hospital, protecting patients from the pathogen of ideology.

—Carson Robinson '12 is a psychology major.