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A serious but little known problem is putting women’s health and lives at risk: because of their religious beliefs, certain health care providers do not give appropriate treatment to women experiencing serious pregnancy complications. A recent study by Ibis Reproductive Health entitled “Assessing hospital polices & practices regarding ectopic pregnancy & miscarriage management” i adds to the growing evidence that the Ethical and Religious Directives for Catholic Health Care Services have been applied to deny women experiencing both ectopic pregnancies and miscarriages the treatment and information to which they are legally entitled. The Directives govern Catholic-affiliated hospitals and provide guidance on a range of reproductive health services including surgical sterilization, family planning, infertility treatment and abortion.ii These are cases in which doctors have determined that there is no medical intervention possible that would allow the patient to continue her pregnancy, and delaying care would only endanger the patient’s health or life.

Catholic-affiliated hospitals are governed by the Directives, which provide guidance Most individuals and even many health providers presume that the Directives’ prohibition on the provision of a range of abortion services applies only to non-emergency pregnancy terminations of otherwise viable pregnancies. But the Study is consistent with anecdotal accounts that provide strong evidence that some hospitals and health care providers have interpreted the Directives to prohibit prompt, medically-indicated treatment of miscarriage and ectopic pregnancy, placing women’s lives and health at additional and unnecessary risk, and violating the laws intended to protect patients from such serious lapses in care.

Hospitals are Required by Law to provide the Standard of Care,vi Yet Hospitals Fail to do so Because of their Adherence to the Directives.

• In some of the miscarriage cases described in the Ibis Study, the standard of care requires immediate treatment. Yet doctors practicing at Catholic-affiliated hospitals were forced to delay treatment while performing medically unnecessary tests. Even though these miscarriages were inevitable and no medical treatment was available to save the fetus, some patients were transferred because doctors could still detect a fetal heartbeat or required to wait until there was no longer a fetal heartbeat to provide the needed medical care.

• Methotrexate, a drug used to treat ectopic pregnancies, is the standard of care for some of the cases described in the Ibis Study. Yet several doctors reported that their hospitals have a blanket prohibition on the drug. This means that women for whom methotrexate would be the best treatment option are instead being subjected to unnecessary and invasive surgical treatment.

Hospitals are Required by Law to provide Emergency Care,vii Yet Hospitals Fail to do so Because of their Adherence to the Directives.

• An article in the American Journal of Public Health (AJPH) reports numerous instances of women who suffered delays in receiving stabilizing care for miscarriages at Catholic hospitals. For example, a Catholic hospital refused to provide the uterine evacuation necessary to stabilize a
patient having a miscarriage, saying that it would only give her blood transfusions as long as
there was still a fetal heartbeat. A doctor at a non-sectarian hospital finally agreed to accept the
transfer of the patient, despite the doctor’s concern that the patient was unstable.

• One doctor in the Ibis Study reported “several instances” of potentially fatal tubal ruptures in
patients with ectopic pregnancies.ix This doctor reported that her Catholic hospital subjected
patients with ectopic pregnancies to unnecessary delays in treatment, despite patients’ exhibiting
serious symptoms indicating that a tubal rupture was possible.

Hospitals are Required by Law to Obtain Patients Informed Consent,x Yet Hospitals Fail to do
so Because of their Adherence to the Directives.

• A doctor interviewed in the Ibis Study said she often takes patients aside and reviews all of
their treatment options, including those forbidden by the hospital, even though this level of
disclosure is not allowed. She reported that other physicians at the hospital offer referrals
and information “under the radar” as well.

• The Directives have even been applied to forbid the treatment of a woman who had suffered a
miscarriage, even thought the fetus no longer had a heartbeat. This case provides an additional
example of a patient with a pregnancy complication being denied essential information about her
condition due to a doctor’s restrictive and in this case, blatantly wrong,xi interpretation of the
Directives. In the course of this refusal, the patient was denied adequate information about her
condition, which hindered her ability to seek care at another facility. http://www.nwlc.org/sites/default/files/pdfs/ibis_factsheet_final.pdf

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