Who can you trust? 

by Groff Schroeder

Injury, illness, limited understanding, and ever-increasing need for access to private information, intimate anatomy, and financial resources have forced patients to trust hospitals for generations.  The vulnerability of patients and the diversity, opportunity and potential rewards of unethical behavior in medicine, especially in the context of desperate family members and literally life and death power of providers, prompted the evolution medical ethics such as Informed Consent over more than 2500 years.  While governments are often assumed to enforce regulations (laws) governing hospitals, private organizations may play a more important role through hospital accreditation. 

Despite these ancient, legal, and societal motivations, patients still appear to routinely endure unethical experiences, especially in America’s religious hospitals.  Although about 13% of America’s hospitals (serving about 5.3 million people) are church run and perceived as religious charities, public funds dominate their financial resources.  One study found that Medicare provides about 27% of public hospital funds, versus 36% for church run hospitals.  The rest of church run hospital funding comes from county appropriations (31%), investments (30%) and not necessarily religious charitable contributions (5%).  Apparently, only about 0.0015% of religious hospital funding comes from the churches that administrate them.  As for charity care, religious hospitals write off as charity care only about 1.9% of their gross patient revenue, versus 0.8% for for-profit hospitals and about 5.1% for secular public hospitals (1). 

In addition paying to fund church run hospitals, We the People might also pay with our lives if we need medical procedures operating churches deny under claims of “freedom of religion.”  Although religious prohibitions vary, virtually all church run hospitals deny reproductive services such as birth control information, procedures and supplies – usually even in cases of rape and incest.  No matter what the patient’s religious beliefs (if any), Catholic run hospitals prohibit all abortions – even when the mother will die and the pregnancy cannot survive. 

While churches can choose whether or not to operate hospitals, patients often seek medical care as a matter of life and death and are often unaware of hospital enforcement of religious law.  Despite ideals such as the “golden rule,” teachings prohibiting dishonesty, and a “patient bill of rights” promising “impartial access to care,” “informed consent,” etc., church run hospitals rarely appear to inform patients that compliance with church law (surrendering their own freedom of religion) is a prerequisite for admission.  Since few patients would knowingly admit themselves into hospitals denying possibly life saving medical information, procedures, and supplies, the absence of information regarding enforcement of church law and concomitant denial of medical procedures in church run hospital admissions contracts appears to successfully mislead patients. 

What is a patient to do?  The Joint Commission on the Accreditation of Hospitals (JCAH) has offered hospital accreditation since 1953 and accepts complaints related to “quality of care” issues including “patient rights, care of patients, safety, infection control, medications and security” at www.jointcommission.org/GeneralPublic/Complaint.  Sadly, it appears that professional medical groups and government agencies avoid involvement in hospital regulation, making patient requests for investigation and enforcement of possible ethical and contractual violations difficult.  As for appeals to the churches operating the hospitals, it appears they have already demonstrated their preference for the exercise of political and religious power over the equality, lives, reproductive rights, and religious freedoms of their patients.   



1. Uttley, L., Pawelko, R., No Strings Attached: Public Funding of Religious Hospitals in the United States, MergerWatch, 2002, http://www.mergerwatch.org/pdfs/bp_no_strings.pdf , accessed July 19, 2010.