And while physicians may not be privately opposed to providing certain services in the spirit of promoting patient care, they are obligated to follow the practices of the institutions in which they work. Such denials of care resulted in patients being turned away (e.g., for pregnancy complications that would have precluded the fetus surviving) and being in critical condition upon arrival at an alternative hospital should they have been lucky enough to find one. Reports indicate patients whose untreated pregnancy complications led to severe bleeding so as to require blood transfusion, a patient whose water had broken prior to viability and the complications of which led to sepsis and kidney injury requiring dialysis, and a patient whose untreated complications nearly required a hysterectomy. It is important to note that all of the physicians cited in the report were unable to perform the medical treatment that they knew was necessary for the patient, because of the hospital policies (e.g., not inducing an abortion if there is a fetal heartbeat).
In the context of frustrations over health insurance and debates over claims denials and "medical necessity," we see opposition to the business of medicine compromising physicians' ability to simply apply their best medical judgment in treating their patients. After all, "do no harm" is not so simple: one may benefit from the medicine in terms of survival but may wake up in tens of thousands of dollars in debt that might lead them to regret having sought care in the first place (leading to psychological distress and in turn, slower physical recovery times, ironically leading quite possibly to even greater costs). Here, it is not the business of medicine mediating physicians' judgments and treatments, but rather the religious affiliation and practices of the institutions through which they provide care. Religion is deeply important to many, and strikes at the core of many individuals' sense of values and identity. The Free Exercise Clause recognizes the importance of the United States government in ensuring individuals' ability to worship free of government interference (though of course also maintaining that there not be any government establishment of religion either). And it is well within a patient's right to seek medical care in a hospital that one views as particularly aligned with their values and morals. However, given the potentially important divergences in preferences over family planning and other policies (along with simply respecting the fact that we are a nation of many different faiths as well as those who do not subscribe to any faith), we should think seriously about the problematic implications of people not having alternative avenues for obtaining needed medical services. At the very least, in the spirit of doing no harm, there should be mandated exceptions for health care for the woman when the professional judgment of the treating physician is such that the medical necessity is clear, and not only at the point of death or near death of the woman.