Martina* laid in the corner room of a busy emergency department. At three in the afternoon she said that she had about one cup of vaginal bleeding that had happened that morning.
“Any chance you could be pregnant?”
She said that she was, in fact, pregnant, but the pregnancy was in her fallopian tube and she was taking a prescription medication, methotrexate, as treatment for her condition. The primary reason for this emergency room visit, she said, was severe abdominal pain. The emergency room physician knew that this signaled a dangerous situation. If the medication did not work, the fallopian tube could rupture, leading to a life-threatening hemorrhage.
“Doctor, one last thing: I’m a Jehovah’s Witness. I cannot receive a blood transfusion.”
Martina's blood pressure was low and her pulse was high. She was bleeding into her abdomen.
The science of medical decision-making requires years of education and medical training. Adding a layer of untrained government regulation will quickly interfere with patient safety and quality of care.
When the Supreme Court recently ruled in favor of Hobby Lobby, it extended the Religious Freedom Restoration Act (RFRA) to closely held companies that object to offering their employees insurance plans that pay for four (of 20 FDA approved) contraceptives. The objections relate to the company owner’s religious beliefs and their interpretation of how these contraceptive methods work. This ruling has intrusively opened the door to complex, private conversations between patients and their doctors, laid the legal landscape for non-medical concerns to interfere with medical decision making, and further marginalized women’s health care.
Martina, a Jehovah’s Witness, would not accept a blood transfusion, despite the fact that she was experiencing life-threatening bleeding into her abdomen. She and her team of health care providers had a robust discussion about this prior to her surgery. Ultimately, this frightened, hemorrhaging woman, now being rushed to the operating room, agreed to receive her own blood (if it could be recycled during the surgery) and a limited number of additional blood products, such as platelets and plasma proteins, if her physicians felt it would be necessary to save her life.
The science of medical decision-making requires years of education and medical training. Adding a layer of untrained government regulation will quickly interfere with patient safety and quality of care. To be sure, oversight of medical care for any reason other than evidence-based science is inappropriate. Oversight by an entity that can’t be trusted to put forth a working website or a crafts store chain so outmoded that they haven’t yet adopted barcode pricing technology is a recipe for disaster.
This Supreme Court ruling has immediate implications for over 70 companies and more than 22,000 employees in the realm of contraception, but the downstream effects could be even more wide-ranging, and not just for women’s health.
While Burwell v. Hobby Lobby focuses narrowly on Christianity as the religion in question in this particular ruing, the slope is slippery indeed. This decision opens the door for a closely held company owned by a Jehovah’s Witness, for example, to refuse to offer employees an insurance plan that covers blood transfusions and related blood products. A closely held company owned by a Christian Scientist could refuse to cover vaccines in its insurance plan.
In the Hobby Lobby ruling, Justice Alito stated that there were alternatives to the objectionable medical treatment available. But alternative therapies may not always have evidence to back them up. Consider vaccines. There are advocates stating that they are unnecessary, but vaccines have led to worldwide eradication of small pox. And early worldwide eradication has been seen with polio, measles, whooping cough, and rubella. Before the rubella vaccine, an epidemic in 1964-65 led to the infection of 12 million Americans, death of 2,000 babies, and 11,000 miscarriages. Not vaccinating, like “bloodless medicine” in Martina’s case, is an “alternative therapy.” Is this really the direction we want to go in?
This court ruling uses medically prescribed treatments specific to women’s health as a political football. Each time an area of women’s health is abused via attempts at government regulation led by political agenda, women are further marginalized and individual rights are encroached upon. Health care decisions, whether made in peril, as with Martina, or in an office setting, are private discussions between patients and their providers.
The Hobby Lobby ruling affects us all. If companies object to where health care dollars are spent, then they have options such as health savings accounts to dissociate their religious conflict. Employers could also choose not to offer an insurance plan and instead pay a penalty. Employees would purchase their own plans and the employer would again be free of religious conflicts.
*The patient’s name has been changed.