Journal of General Internal Medicine

, Volume 25, Issue 7, pp 725–730 | Cite as

Religious Hospitals and Primary Care Physicians: Conflicts over Policies for Patient Care

  • Debra B. StulbergEmail author
  • Ryan E. Lawrence
  • Jason Shattuck
  • Farr A. Curlin
Original Research



Religiously affiliated hospitals provide nearly 20% of US beds, and many prohibit certain end-of-life and reproductive health treatments. Little is known about physician experiences in religious institutions.


Assess primary care physicians’ experiences and beliefs regarding conflict with religious hospital policies for patient care.


Cross-sectional survey.


General internists, family physicians, and general practitioners from the AMA Masterfile.


In a questionnaire mailed in 2007, we asked physicians whether they had worked in a religiously affiliated hospital or practice, whether they had experienced conflict with the institution over religiously based patient care policies and how they believed physicians should respond to such conflicts. We used chi-square and multivariate logistic regression to examine associations between physicians’ demographic and religious characteristics and their responses.


Of 879 eligible physicians, 446 (51%) responded. In analyses adjusting for survey design, 43% had worked in a religiously affiliated institution. Among these, 19% had experienced conflict over religiously based policies. Most physicians (86%) believed when clinical judgment conflicts with religious hospital policy, physicians should refer patients to another institution. Compared with physicians ages 26–29 years, older physicians were less likely to have experienced conflict with religiously based policies [odds ratio (95% confidence interval) compared with 30–34 years: 0.02 (0.00–0.11); 35–46 years: 0.07 (0.01–0.72); 47–60 years: 0.02 (0.00–0.10)]. Compared with those who never attend religious services, those who do attend were less likely to have experienced conflict [attend once a month or less: odds ratio 0.06 (0.01–0.29); attend twice a month or more: 0.22 (0.05–0.98)]. Respondents with no religious affiliation were more likely than others to believe doctors should disregard religiously based policies that conflict with clinical judgment (13% vs. 3%; p = 0.005).


Hospitals and policy-makers may need to balance the competing claims of physician autonomy and religiously based institutional policies.


religion conscience primary care hospital policy health policy 



Funding for this work was provided by the Greenwall Foundation, New York, NY, and the National Center for Complementary and Alternative Medicine (1 K23 AT002749). Mr. Lawrence’s time was supported by the University of Chicago Pritzker School of Medicine Summer Research Program. The study was presented at the annual meeting of the North American Primary Care Group, November 18, 2008.

We thank Joshua Kellemen for assistance with data collection and management; Kenneth Rasinski for assistance with data analysis; and Bernard Ewigman for manuscript review.

Conflicts of Interest

None disclosed.

Supplementary material

11606_2010_1329_MOESM1_ESM.pdf (410 kb)
ESM 1 (PDF 410 kb)


  1. 1.
    Uttley LJ, Pawelko R. No strings attached: Public funding of religiously-sponsored hospitals in the United States. New York: MergerWatch; 2002.Google Scholar
  2. 2.
    United States Conference of Catholic Bishops. Ethical and religious directives for Catholic health care services. 5th ed. Washington: United States Conference of Catholic Bishops; 2009.Google Scholar
  3. 3.
    Chuang CH, Waldman LJ, Freund KM, Ash AS. Emergency contraception: Prescribing practices of general internists compared with other primary care physicians. Contraception. 2004;69:43–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Bartman BA, Weiss KB. Women’s primary care in the United States: A study of practice variation among physician specialties. J Womens Health. 1993;2(3):261–8.CrossRefGoogle Scholar
  5. 5.
    Landefeld CS, Callahan CM, Woolard N. General internal medicine and geriatrics: Building a foundation to improve the training of general internists in the care of older adults. Ann Intern Med. 2003;139(7):609–14.PubMedGoogle Scholar
  6. 6.
    Warshaw G, Murphy J, Buehler J, Singleton S. Geriatric medicine training for family practice residents in teh 21st century: A report from the residency assistance Program/Hartford geriatrics initiative. Fam Med. 2003;35(1):24–9.PubMedGoogle Scholar
  7. 7.
    Hazzard WR, Woolard N, Regenstreif DI. Internal medicine: At the nexus of the health care system in respoding to the demographic imperative of an aging population. Am J Med. 2001;110:507–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Breen CM, Abernethy AP, Abbott KH, Tulksy JA. Conflict associated with decisions to limit life-sustaining treatment in intensive care units. J Gen Intern Med. 2001;16:283–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Curlin FA, Lawrence RE, Chin MH, Lantos JD. Religion, conscience, and controversial clinical practices. N Engl J Med. 2007;356(6):593–600.CrossRefPubMedGoogle Scholar
  10. 10.
    Thompson DF. The institutional turn in professional ethics. Ethics Behav. 1999;9(2):109–18.CrossRefPubMedGoogle Scholar
  11. 11.
    Raghavan R. A question of faith. JAMA. 2007;297(13):1412.CrossRefPubMedGoogle Scholar
  12. 12.
    Freedman LR, Landy U, Steinauer J. When there’s a heartbeat: Miscarriage management in Catholic-owned hospitals. Am J Public Health. 2008;98(10):1–5.CrossRefGoogle Scholar
  13. 13.
    Electronic Code of Federal Regulations. Title 45 Part 88. Ensuring that Department of Health and Human Services Funds do Not Support Coercive Or Discriminatory Policies Or Practices in Violation of Federal Law. Available at Accessed February 2, 2010.
  14. 14.
    Stein R. Health workers’ ‘conscience’ rule set to be voided. Washington Post. 2009(A01); Feb 28, 2009.Google Scholar
  15. 15.
    Hitt G. GOP antiabortion provision in health bill defeated. Wall Street Journal. 2009(A6), Oct 1.Google Scholar
  16. 16.
    Stein R. Workers’ religious freedom vs. patients’ rights. Washington Post. 2008(A01), July 31.Google Scholar
  17. 17.
    Labi N. Holy owned. is it fair for a Catholic hospital to impose its morals on patients? Time. 1999;154(20):85–6.PubMedGoogle Scholar
  18. 18.
    Lauderdale DS, Kestenbaum B. Asian american ethnic identification by surname. Popul Res Policy Rev. 2000;19(3):283.CrossRefGoogle Scholar
  19. 19.
    Lauderdale DS. Birth outcomes for arabic-named women in california before and after september 11. Demography. 2006;43(1):185–201.CrossRefPubMedGoogle Scholar
  20. 20.
    Allport GW, Ross JM. Personal religious orientation and prejudice. J Pers Soc Psychol. 1967;5(4):432–43.CrossRefPubMedGoogle Scholar
  21. 21.
    Hill PC, Hood RW, eds. Measures of religiosity. Birmingham, Ala.: Religious Education Press; 1999.Google Scholar
  22. 22.
    Curlin FA, Lantos JD, Roach CJ, Sellergren SA, Chin MH. Religious characteristics of US physicians: A national survey. J Gen Intern Med. 2005;20(7):629–34.CrossRefPubMedGoogle Scholar
  23. 23.
    Groves RM, Fowler FJ Jr, Couper MP, Lepkowski JM, Singer E, Tourageau R. Survey methodology. New Jersey: John Wiley and Sons; 2004:326.Google Scholar
  24. 24.
    Uttley LJ. How merging religious and secular hospitals can threaten health care. Soc Policy. 2000;30(3):4–13.Google Scholar
  25. 25.
    Harrison T. Availability of emergency contraception: A survey of hospital emergency department staff. Ann Emerg Med. 2005;46(2):105–10.CrossRefPubMedGoogle Scholar
  26. 26.
    Lawrence RE, Curlin FA. Physicians’ beliefs about conscience in medicine: A national survey. Acad Med. 2009;84(9):1276–82.CrossRefPubMedGoogle Scholar
  27. 27.
    Lawrence RE, Curlin FA. Autonomy, religion and clinical decisions: Findings from a national physician survey. J Med Ethics. 2009;35(4):214–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Winkler EC. The ethics of policy writing: How should hospitals deal with moral disagreement about controversial medical practices? J Med Ethics. 2005;31(10):559–66.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Debra B. Stulberg
    • 1
    • 2
    • 3
    Email author
  • Ryan E. Lawrence
    • 4
  • Jason Shattuck
    • 5
  • Farr A. Curlin
    • 3
    • 6
  1. 1.Department of Family MedicineThe University of ChicagoChicagoUSA
  2. 2.Section of Family Planning, Department of Obstetrics & GynecologyThe University of ChicagoChicagoUSA
  3. 3.MacLean Center for Clinical Medical EthicsThe University of ChicagoChicagoUSA
  4. 4.Pritzker School of MedicineThe University of ChicagoChicagoUSA
  5. 5.Internal Medicine/PediatricsWenatchee Valley Medical CenterWenatcheeUSA
  6. 6.Section of General Internal Medicine, Department of Internal MedicineThe University of ChicagoChicagoUSA

Personalised recommendations