Organizational, Institutional, and Policy Restrictions that Allow Denials of Reproductive Health Care

People expect that the health care they receive meets the prevailing medical standard of care. When this care is not provided, the health care system fails both the individual patient and the general public. It is the responsibility of both health care providers and policy makers to ensure that patients receive quality health care.

The quality of women's reproductive health services is undermined by external restrictions which have little to do with medical evidence, good medical practice or the needs of the patient. These restrictions emanate from a number of sources: ideological, political and financial. Regardless of the source, these restrictions should be scrutinized to assess their impact on women's health and redressed when they fall below the standard of care. Institutions that impose ideologically-based directives have assumed increasing control of hospitals and health systems in the United States. These organizations often impose limitations on the health care that clinicians can provide. Broad statutory refusal clauses allowing health care personnel to refuse to provide critical services and information based on their personal beliefs also are proliferating. When imposed, patients may be denied access to health care, and long-standing principles of informed consent may be violated.

This paper discusses the sources of restrictions on care and the implications for those restrictions on patient decision-making, health outcomes, and provider practices. It further discusses the framework for analyzing whether and to what extent these denials conflict with professionally-developed, accepted medical standards of care, and the potential medical and health consequences on patients.