Doctors' beliefs can hinder patient care

By Sabrina Rubin Erdely

updated 2:26 p.m. ET June 22, 2007

Lori Boyer couldn't stop trembling as she sat on the examining table, hugging her hospital gown around her. Her mind was reeling. She'd been raped hours earlier by a man she knew — a man who had assured Boyer, 35, that he only wanted to hang out at his place and talk. Instead, he had thrown her onto his bed and assaulted her. "I'm done with you," he'd tonelessly told her afterward. Boyer had grabbed her clothes and dashed for her car in the freezing predawn darkness. Yet she'd had the clarity to drive straight to the nearest emergency room — Good Samaritan Hospital in Lebanon, Pennsylvania — to ask for a rape kit and talk to a sexual assault counselor. Bruised and in pain, she grimaced through the pelvic exam. Now, as Boyer watched Martin Gish, M.D., jot some final notes into her chart, she thought of something the rape counselor had mentioned earlier.

"I'll need the morning-after pill," she told him.

Dr. Gish looked up. He was a trim, middle-aged man with graying hair and, Boyer thought, an aloof manner. "No," Boyer says he replied abruptly. "I can't do that." He turned back to his writing.

Boyer stared in disbelief. No? She tried vainly to hold back tears as she reasoned with the doctor: She was midcycle, putting her in danger of getting pregnant. Emergency contraception is most effective within a short time frame, ideally 72 hours. If he wasn't willing to write an EC prescription, she'd be glad to see a different doctor. Dr. Gish simply shook his head. "It's against my religion," he said, according to Boyer. (When contacted, the doctor declined to comment for this article.)

video 'Morning-after' debate moves to ERs June 22: Can states force Catholic hospitals to offer the 'morning-after" pill? MSNBC

Boyer left the emergency room empty-handed. "I was so vulnerable," she says. "I felt victimized all over again. First the rape, and then the doctor making me feel powerless." Later that day, her rape counselor found Boyer a physician who would prescribe her EC. But Boyer remained haunted by the ER doctor's refusal — so profoundly, she hasn't been to see a gynecologist in the two and a half years since. "I haven't gotten the nerve up to go, for fear of being judged again," she says.

Doctors refusing treatment
Even under less dire circumstances than Boyer's, it's not always easy talking to your doctor about sex. Whether you're asking about birth control, STDs or infertility, these discussions can be tinged with self-consciousness, even embarrassment. Now imagine those same conversations, but supercharged by the anxiety that your doctor might respond with moral condemnation — and actually refuse your requests.

That's exactly what's happening in medical offices and hospitals around the country: Catholic and conservative Christian health care providers are denying women a range of standard, legal medical care. Planned Parenthood M.D.s report patients coming to them because other gynecologists would not dole out birth control prescriptions or abortion referrals. Infertility clinics have turned away lesbians and unmarried women; anesthesiologists and obstetricians are refusing to do sterilizations; Catholic hospitals have delayed ending doomed pregnancies because abortions are only allowed to save the life of the mother. In a survey published this year in The New England Journal of Medicine, 63 percent of doctors said it is acceptable to tell patients they have moral objections to treatments, and 18 percent felt no obligation to refer patients elsewhere. And in a recent SELF.com poll, nearly 1 in 20 respondents said their doctors had refused to treat them for moral, ethical or religious reasons. "It's obscene," says Jamie D. Brooks, a former staff attorney for the National Health Law Program who continues to work on projects with the Los Angeles advocacy group. "Doctors swear an oath to serve their patients. But instead, they are allowing their religious beliefs to compromise patient care. And too often, the victims of this practice are women."

The state of doctor refusals Physicians anywhere can deny you care. But some states back up M.D.s with specific laws allowing them to do so, says Elizabeth Nash, public policy associate at the Guttmacher Institute research group. Whose side is your state on? States that allow doctors to refuse care Contraception AR, CO, FL, IL, ME, MS, TN, WA Abortion Every state has a law except AL, NH, VT, WV. Sterilization AR, GA, ID, IL, KS, KY, MD, MA, MS, MT, NJ, PA, RI, WA, WV, WI States that allow hospitals to refuse care Contraception All hospitals IL, MS, WA Private hospitals only AR, CO, ME, MA, NJ, TN Abortion All hospitals AZ, AR, CO, DE, FL, GA, HI, ID, KS, KY, LA, ME, MD, MA, MI, MS, MO, NE, NM, NC, ND, OH, SD, TN, VA, WA, WI Private hospitals only AK, IL, IN, IA, MN, MT, NV, NJ, OK, OR, PA, SC, TX, UT, WY Religious hospitals only CA Sterilization All hospitals AR, GA, ID, IL, KS, MD, MS, NM, WA, WV, WI Private hospitals only MA, MT, NJ, PA States considering new laws Lawmakers in Missouri, Rhode Island, South Carolina and Vermont are considering sweeping bills that would allow medical professionals to refuse to provide any service they object to.

Compared with the highly publicized issue of pharmacists who refuse to dispense birth control and emergency contraception, physician refusals are a little-discussed topic. Patients denied treatment rarely complain — the situation tends to feel so humiliatingly personal. And when patients do make noise, the case is usually resolved quietly. "The whole situation was traumatizing and embarrassing, and I just wanted to put it behind me," Boyer says. She came forward only after a local newspaper reported an almost identical story: In July 2006, retail clerk Tara Harnish visited the same ER after being sexually assaulted by a stranger, was examined by the same Dr. Gish — and when her mother called Dr. Gish's office the next day to get EC for Harnish, she was refused. "Then I knew it wasn't just me, that this was a larger problem and it could happen to anybody," Boyer says.

Harnish, 21, was shocked by the way the doctor treated her. "He seemed more concerned with saving the (potential) pregnancy than he was with my health," she says. "He turned me away when I needed medical help. That's not what a doctor is supposed to do." Harnish was too shaken by her rape to pursue the matter; her mother called Harnish's gynecologist for a prescription. Then she called the newspaper. Despite the attention the story attracted, Dr. Gish continues to work at Good Samaritan Hospital. Spokesman Bill Carpenter will only say that "the issue has been resolved internally, and we're going to move forward."

In many cases, women don't even know a doctor is withholding treatment. Boyer and Harnish, for example, wouldn't have realized they'd been denied care if they'd been among the estimated one in three women who don't know about EC. In the New England Journal of Medicine survey, 8 percent of physicians said they felt no obligation to present all options to their patients. "When you see a doctor, you presume you're getting all the information you need to make a decision," notes Jill Morrison, senior counsel for health and reproductive rights at the National Women's Law Center in Washington, D.C. "Especially in a crisis situation, like a rape, you often don't think to question your care. But unfortunately, now we can't even trust doctors to tell us what we need to know."

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