Among providers working at Catholic hospitals, willingness and ability to offer referrals for reproductive health services prohibited by church doctrine vary widely, according to "Referrals for Services Prohibited in Catholic Health Care Facilities," by Debra B. Stulberg, of the University of Chicago, et al. Additionally, providers reported that even when they were willing and able to provide referrals, patients seeking abortion services were handled very differently and raised more concerns among hospital and office staff than did those seeking other prohibited care.

Catholic hospitals make up a growing share of hospitals in the United States, and clinicians in these facilities are bound by Catholic doctrine that prohibits the provision of sterilization and contraceptive services, abortion and fertility treatments. Counterbalancing these prohibitions, the Committee on Ethics of the American College of Obstetricians and Gynecologists has determined that a physician who cannot provide a patient with a requested and medically accepted reproductive health service because of a religious or moral objection must provide a timely referral to a provider who can. Yet there has been little research into how common this practice is.

In 2011–2012, Stulberg and her colleagues conducted in-depth interviews with 27 obstetrician-gynecologists who were currently working or had previously worked in Catholic facilities. The authors explored providers’ experiences with and perspectives on whether referrals for services prohibited by church doctrine are offered at Catholic facilities, how those referrals are handled and whether patients’ needs are met. They found very mixed results.

Some respondents reported that hospital ethics authorities encouraged them to make referrals or to indirectly refer (e.g., tell patients they could seek services elsewhere, but not help them to do so), while others reported that they did not know if the administration was aware that they were making referrals or providing information behind closed doors. Still others reported that hospital authorities actively discouraged referrals. Providers described three common scenarios in which they felt that their patients’ needs were not met: Patients who sought tubal ligation postpartum or at the time of a cesarean were not served by referrals, which required a second procedure or hospitalization; patients with limited financial resources faced barriers in accessing referred services; and patients who needed emergency treatment were not always able to obtain services at the hospital at which they presented.

The authors suggest that given the potential tension between providers’ views and those of the Catholic Church, the variety in providers’ reports of whether the referral process met their patients’ medical needs is not surprising. Arguing that their study illustrates the complexity of translating religious teachings into clinical practice, they stress that there are serious implications for patient care and public policy. In particular, they conclude, religious entities that are involved in health care should be required to ensure that patients are well informed about the limitations of available services and able to receive the care they need.

"Referrals for Services Prohibited in Catholic Health Care Facilities," by Debra B. Stulberg, of the University of Chicago, et al., was published in Perspectives on Sexual and Reproductive Health and is currently available online.