(Dr. Barbara Morris, a geriatrician, was fired from Centura Health for attempting to help a patient use Colorado’s aid-in-dying law. She accepted a job with Stride Community Health Center’s Union Square Plaza location in Lakewood. Union Square Plaza is the key clinic in the GWEP grant pilot to serve the local aging population. Top GWEP project initiatives include geriatric care training for medical providers, an oral health training initiative, advancing academic and clinical practice partnerships, facilitating a virtual dementia training program and supporting clinic transformation into age-friendly health systems.)
Neil didn’t like doctors or hospitals at all. He rarely visited either but managed to develop a trusting relationship with our geriatric practice. When he developed gastrointestinal symptoms and was diagnosed with an aggressive and metastatic cancer, he sought care from us. His oncologist had been blunt: the prognosis was bleak – without chemotherapy a few short weeks, with chemotherapy, perhaps six months. Because he had experienced his mother’s painful and excruciating decline and death, Neil wanted something else for himself.
In 2013, I began a position for Centura Health Physician Group in Denver as Medical Director for Senior Services, as well as having an ambulatory geriatrics practice as an employed physician in this large faith-based healthcare system. When I signed the initial and subsequent updated contracts, they included an agreement to abide by the ethical and religious directives (ERDs) of the Catholic/Adventist system. At that time, Colorado’s End of Life Options Act (ELOA) was still a draft on paper.
In 2016, the people of Colorado overwhelmingly passed Proposition 106, The End-of-Life Options Act. When it went into effect in early 2017, ELOA allowed patients with terminal illness to request medical-aid-in-dying (MAiD) medications from physicians. The act also provided a structured and detailed process to insure appropriateness of requests and care. Health care systems were given the option to opt-out and prevent employed physicians from participating under specific circumstances. According to the act, “A health-care facility may prohibit a physician employed or under contract from writing a prescription for medical aid-in-dying medication for a qualified individual who intends to use the medical aid-in-dying medication on the facility’s premises (emphasis added). The health-care facility must notify the physician in writing of its policy about prescriptions for medical aid-in-dying medication. A health-care facility that fails to provide advance notice to the physician shall not be entitled to enforce such a policy against the physician.” (C.R.S. Title 25, Art. 48). Those systems making the choice to opt-out are required to notify patients as well. However, in early 2017, Centura implemented a policy prohibiting its employed physicians from participating in any way in medical aid in dying regardless of where the patient intended to use the medication.
Knowing his days were numbered and that he faced unimaginable pain and suffering, Neil requested consideration for MAiD in the summer of 2019. It was his wish to have control over his inevitable death, which he hoped would be in his own home. Imagine his dismay when I told him that despite the passage of the ELOA, Centura had a policy prohibiting me from helping him with his request; he did not know that the health system had opted out of participation. Though offered the choice of being referred to one of the other health systems in Denver providing MAiD services, Neil was devastated that his own health system couldn’t provide care for him, and he did not wish to start over with another physician and another group. Together, we asked the District Court in Colorado to review the Centura policy to determine if it was compliant with the ELOA. Five days after the declaratory action requesting this review was filed, Centura fired me for breach of contract. Neil was left without his physician and without a health system to care for him.
In Colorado, 36% of our hospitals are Catholic owned and managed. These hospitals and their corresponding health systems require that their physicians and staff adhere to the ERDs, which prohibit (among other things) participation in MAiD services, despite the ELOA giving patients the legal right to request MAiD and stipulating that health systems can only opt out for those patients wishing to use the medication on their premises. This problem is not unique to Colorado. Increasingly across the United States, faith-based hospital systems (especially Catholic entities) are becoming the predominant or sole source of care. Though these entities receive significant federal funding, they have not been prevented from restricting care related to end-of-life decisions, as well as in the reproductive health care arena. Unfortunately, patients may not be aware that their health care system is faith-based, and rarely understand the restrictions that their health systems have implemented — until they need this care. The variable rules about notification of such restrictions and the health systems habits of burying such notifications in other lengthy documents make it difficult for patients to be knowledgeable about how their care delivery system may interfere with their profoundly personal and legally protected health choices.
Patients and employed clinicians need to be proactive and prepared. For patients, asking questions and investigating a health system’s policies and restrictions, though daunting, is imperative if they don’t want to find themselves in Neil’s devastating circumstance. Furthermore, patients interested in actively addressing this problem can work together to demand greater transparency from health care systems. For clinicians, understanding a current or prospective employer’s policies and contract terms, which may be more restrictive than federal and state statutes, should be part of every employment decision. When faced with potential conflict between health system restrictions and personal conviction, each patient and clinician will be faced with difficult but important options. Armed with information and understanding, each will be better able to make an appropriate choice for themselves, their families, and their patients.
Thank you for posting this important — and outrageous — article!! What happened to church/state separation — and is this going to get worse with SCOTUS? What is the recourse to situations like this? I suppose the religious opponents would recommend a gun in every household when you can’t get help from your own doctor!
I’m glad as well as horrified to read this. It makes me realize it’s been way too long since I emailed my non-profit local hospital and healthcare system asking about any change in policies regarding my Advance Directive they already have on file since they were taken over (“became a partner with”) Dignity Health, which is Catholic. Of course I’ve gotten no reply, and was never able to reach anyone useful on the phone. Time to start trying again.
Choice just took a big hit. End-of-life choice may be a target soon. It’s time for people who hope to have the right to end life on their own terms to actively defend it.
Cruelty comes in many guises. Sometimes it’s so ubiquitous, one doesn’t even recognize it. The Providence healthcare system in Sonoma County (CA) will not abide by the End of Life Care Options Act. They forbid their physicians, employees, contractors and volunteers to knowingly provide, deliver, administer or assist with the administration of any medication used as part of the End of Life Options Act. Furthermore, the clincher, “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.” Christopher Hitchens explores this repugnant concept in his book “The Missionary Position.”
How can someone *not* know a hospital or health system has a religious affiliation (Christian or otherwise)? My late husband and I, Anglican Christians, knew that the closest hospital to his long-term care center was Catholic. When you enter their hospitals, there are statues of Mary and/or Jesus before or shortly after entering the buildings? I wasn’t fond of the health system with which this hospital is affiliated, not because of its religious perspective, but because it’s not an academic medical center. When he was hospitalized there, there were chaplaincy services, but not all chaplains were Catholic, although the chaplains included Catholic priests, deacons, and consecrated religious sisters. He once had a religious sister as a chaplain and she was wonderful. Didn’t push her religion on us at all. Same thing occurred with my late father, who was hospitalized in *St. Mary’s Hospital* (religious affiliation rather obvious). A religious sister was the chaplain for his unit, but she readily arranged for visits from his own Lutheran pastor.
Important read on the impact of religious restrictions in healthcare. Your insights highlight the need for patient autonomy and informed choices. Thank you for raising awareness on this sensitive topic!