Patient Views on Religious Institutional Health Care

Maryam Guiahi,Debra Stulberg,Stephanie B Teal,Patricia E Helbin,Jeanelle Sheeder

doi:10.1001/jamanetworkopen.2019.17008

Abstract

Federal protections allow health facilities to limit options to patients on the basis of religious values. Little is known about whether US adults consider religious affiliation when selecting facilities and whether they agree with such limitations. To understand patient views on religious institutional care. This is a population-based, cross-sectional survey study of US adults recruited from the probability-based AmeriSpeak Omnibus panel available from NORC (formerly the National Opinion Research Center) at the University of Chicago. Surveys were administered via internet or telephone during a 3-day fielding period in November 2017. Data analysis was performed from January 2018 to October 2019. Participant characteristics, including religiosity measures. Whether patients consider religious affiliation when selecting a health care facility and their views on whether an institution's religious values should take precedence over their health choices. Responses were compared by gender. When gender differences existed, regression models were performed, and thematic content analysis was applied to open-ended responses. There were 1446 participants (745 [51.5%] male; mean [SD] age, 46 [17] years), for a survey completion rate of 24.5% and weighted cumulative response weight of 7.3%. Most respondents (62.6%) were white, and the most common religion was Protestant (28.2%). When specifically asked, only 6.4% reported that they considered religious affiliation when selecting a health care facility; most participants (71.3%) reported when selecting a health care facility that they did not care whether it is religiously affiliated, 13.4% preferred a religious affiliation, and 15.3% preferred no religious affiliation. There were no gender differences. Most participants (71.4%) believed that their health choices should take priority over an institution's religious affiliation in services offered, and this was more common for women than for men (74.9% vs 68.1%; difference, 6.8%; 95% CI, 5.6%-8.2%; P = .005), who more commonly endorsed concerns for personal choice and autonomy over one's own body. This study suggests that most patients value their personal choices, yet do not consider an institution's religious affiliation when choosing their source of health care. Women placed greater emphasis on their autonomy in comparison with an institution's right to invoke religious restrictions to care. Given the growth in ownership of health care facilities by religious entities in the United States and increasing attention to conscientious objections, these findings point to a need for advocacy and legislation that effectively balances protections for religious institutions with protections for patients.

Highlights

The nature of US health care is shifting, in part because of the growing religious ownership sector
Only 6.4% reported that they considered religious affiliation when selecting a health care facility; most participants (71.3%) reported when selecting a health care facility that they did not care whether it is religiously affiliated, 13.4% preferred a religious affiliation, and 15.3% preferred no religious affiliation
Most participants (71.4%) believed that their health choices should take priority over an institution’s religious affiliation in services offered, and this was more common for women than for men (74.9% vs 68.1%; difference, 6.8%; 95% CI, 5.6%-8.2%; P = .005), who more commonly endorsed concerns for personal choice and autonomy over one’s own body

Summary

Introduction

The nature of US health care is shifting, in part because of the growing religious ownership sector. In 2016, 10 of the top 25 health care systems were Catholic sponsored.[1] Almost half (46%) of all US Catholic hospitals are located in the Midwest,[2] and 46 Catholic hospitals are designated as sole community hospitals because of their remote location from other major medical centers.[1]. Attendance at religious health care facilities can affect a patient’s access to services because of religious interpretations about care designated by the institution. Prior evidence[4] has highlighted restrictions to care in Catholic facilities specific to contraception, sterilization, miscarriage management, and abortion. Recent media reports have highlighted conflicts in care with respect to transgender health and medical aid in dying. In other non-Catholic religious hospitals, contraceptive and sterilization services are generally provided, whereas abortion care is often restricted.[5]

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