Balancing Religious Freedom and Patient Rights

Catholic Hospitals in the United States: Balancing Religious Freedom and Patient Rights

By Priyanka Ray

Table of Contents

• Introduction
• Autonomy
• The Principle of Double Effect
• Slippery Slope
• Conscientious Objection
• Religious Freedom in Corporations
• Conscience Clause Legislation
• Conclusion

It might be surprising for most people to learn that twelve percent of hospitals in the United States are affiliated with the Catholic Church and many act as the sole provider of reproductive healthcare in rural areas (Catholics for Choice). More than a quarter of Catholic hospitals are located in rural areas, meaning that there are often no other viable health care options for people living in those areas, especially the poor. Four of the top 10 largest nonprofit health care systems are Catholic owned, including the largest. Out of the top 10 religious health care systems, nine are Catholic owned and operated. One in six hospitalized patients in the United States is cared for in a Catholic health care facility. The 620 Catholic hospitals across the country make up 12.4 percent of the nation’s 5,010 community hospitals. There are more than 1,400 additional U.S. Catholic long-term and other health care facilities. Catholic hospitals handle more than 30 percent of all admissions in Alaska, Iowa, Oregon, South Dakota and Wisconsin and 20 to 30 percent of admissions in another 17 states (Catholics for Choice).  At these hospitals women in need of lifesaving abortions may be denied treatment or information.

Hospitals in the United States that are affiliated with the Catholic Church must adhere to a list of 72 Ethical and Religious Directives issued by the United States Conference of Catholic Bishops. Concerning abortion, the Ethical and Religious Directives state that  “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers” (United States Conference of Catholic Bishops).  The principle of material cooperation is any type of cooperation in which the agent does not intend the negative effects, but only the good. Therefore, in accordance with the USCCB regulations, Catholic hospitals are not to provide abortions, even in extreme circumstances. Additionally, all Catholic affiliated hospitals are a part of the Catholic Health Association,  a national leadership organization of more than 1200 Catholic health care sponsors, systems, facilities, and related organizations and services. While non-Catholic physicians may work at Catholic hospitals, they must be willing to adhere to the 72 directives (US Catholic). The belief in the dignity of human life from the moment of conception until death is the cornerstone of Catholic healthcare systems. Providing patients with treatments such as abortion would go against a Catholic hospital’s mission to respect the “dignity of life” as well as provide compassionate care, as treatments such as these are clearly stated to be immoral and non-beneficial towards patients due to their inherently “ungodly” nature (United States Conference of Catholic Bishops). The USCCB regulations create tension between the religious and moral beliefs of the hospital and the obligations of a physician.  In accordance with the USCCB regulations, women in need of lifesaving abortions often do not receive treatment or information . However, not providing treatment or information may violate a Catholic hospital’s mission to provide “compassionate care.” 

 In December 2010 Tamesha Means, a woman from rural Muskegon, Michigan, was 18 weeks pregnant when her water broke. She was rushed to Mercy Health Partners, a Catholic hospital and the only hospital within thirty minutes of her home. MHP did not inform Means that, due to her condition, the fetus she was carrying had virtually no chance of surviving, and continuing her pregnancy would pose a serious risk to her health. MHP did not tell Means that the safest treatment option was to induce labor and terminate the pregnancy. MHP sent Means home.  Means returned to MHP the next day, bleeding and with painful contractions. MHP sent Means home without telling her about all of the treatment options. Means returned to MHP later that night. As Means waited to be sent home for the third time, she began to deliver. The baby died shortly after birth (ACLU). 

Means’ case raises many ethical issues and questions, specifically those pertaining to  autonomy and fairness.  The physicians at MHP denied Means treatment and information, therefore risking her life. Does a religious hospital/physician’s conscientious objection allow them to deny treatment/information from a patient, even when the patient’s life is in danger? What are the ethics of denying treatment/information to patients based on conscientious objection when the patient’s life is at stake vs. when the patient’s life is not at stake? What is the difference between denying treatment from a patient vs. withholding information from a patient? Physicians take an oath to “Do No Harm” and adhere to the principles of beneficence and nonmaleficence. Doctors have an obligation to provide patients with best medical care. How do physicians at religious hospitals like MHP balance their obligations towards their patients (best medical practice) while retaining their autonomy? Means’ right to retain her autonomy as well as her right to “informed consent” clashed directly with the autonomy of MHP as well as MHP’s right to conscientiously object based on religious grounds. How do we balance a patient’s right to retain their autonomy with a physician/ hospital’s right to conscientiously object to practices which they view as morally or religiously reprehensible?

I will also explore these ethical concerns as they relate to the law. What is the distinction between a legal obligation and a moral right/decision? What legal mechanisms are in place that allow Catholic hospitals like MHP to refuse to perform lifesaving abortions? As an institution, can MHP have the same religious freedom as individuals? Individuals have autonomy. Can a corporation have autonomy too?  Finally, I will explore the ethical issue of fairness. Due to Means’ geographic location, she was unable to access a secular hospital. What can be done about the issue of equity, and the fact that poor women in rural areas like Means often do not have access to secular hospitals? 

Overall, This paper will focus on Catholic hospitals and whether or not physicians at these hospitals have the right to deny treatment or withhold  information from patients if the treatment/information goes against the religious and moral beliefs of the hospital. This paper will focus on the ethical issues of patient autonomy, physician autonomy/paternalism, and fairness. This paper will consider the physician-patient relationship and will explore the clash between a hospital’s right to express their religious beliefs and a hospital’s obligation to provide patients with the treatment options they need. The broad themes covered in this paper are Women’s Health and Reproductive Rights, Religious Freedom in an Individual v. an Institution, and the distinction between a moral decision/right and a legal obligation. The ethical issues explored in this paper are relevant because many people do not have access to secular hospitals.

In the current healthcare system, patient autonomy is often valued above paternalism. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. Physicians are expected to inform patients of all viable treatment options, and patients expect to have the final say in their treatment plan. 

Personal autonomy is widely valued: most people think it is preferable to somehow be their own person and shape their own lives than to live under the control of others (Jameton). The idea that patients should be offered options and allowed to make voluntary choices about potentially life-changing health care interventions is important. “Recognition of the particular vulnerability of patients’ autonomy has underpinned the inclusion of respect for autonomy as a key concern in biomedical ethics”  (Fogel).  This protects patients from inappropriate paternalism and unwanted intervention. Examples of inappropriate and unwanted paternalism include the forced sterilization of predominantly poor, African-American, Latino, and Native American women during the late 19th and early 20th centuries as well as the Tuskegee Syphilis Experiment

In religiously affiliated hospitals, patients are sometimes unable to receive treatment or information about treatment options, which they may want or need. While physicians with strongly held religious beliefs feel that they are unable to inform patients of what they view as immoral treatment options, we must also consider that this illustrates an example of a physician projecting their religious beliefs onto a patient, disrespecting their autonomy. From the perspective of a patient who does not hold the same deeply held religious beliefs as the physician, the physician is unwilling to inform them of treatment options due to his/her religious belief (Meyers). Should religiously affiliated hospitals be obligated to present patients with all treatment options (even if the hospital refuses to actually carry them out)? While physicians/hospitals should not be forced to perform treatments which they deem as morally reprehensible, physicians/hospitals have an obligation to inform patients about all treatment options.  By not informing a patient of all their treatment options, a hospital/physician denies a patient of their autonomy. When MHP did not tell Means all of her treatment options, they undermined her autonomy and did not respect her right to “informed consent.” Informed consent plays an integral role in ensuring that a patient retains their autonomy. In a Catholic hospital, informed consent (which is deemed as a patient right) can clash with the moral/religious beliefs of the hospital. 

A patient’s right to make autonomous and well informed decisions often clashes with a hospital/physician’s right to practice their religious/moral beliefs. Catholic hospitals continue to adhere to a paternalistic view of healthcare. Catholic hospitals must follow the 72 directives issued by the USCCB which declare what “best medical practice” looks like in a Catholic hospital. 

There is a clash between what patients may view as “best medical practice” and what physicians in religious hospitals may view as “best medical practice” due to their strongly held religious beliefs. In Catholic hospitals, physicians refuse both treatment and information from patients. While patients have a right to make autonomous decisions, hospitals also have the right to practice their religious and moral beliefs. 

All hospitals, even religious ones, have obligations towards their patients. Physicians take an oath to “Do No Harm,” an idea espoused in the principle of beneficence.  Beneficence is action that is done for the benefit of others. Beneficent actions can be taken to help prevent or remove harms or to simply improve the situation of others. Physicians are expected to refrain from causing harm, but they also have an obligation to help their patients. Doctors  have an obligation to prevent and remove harms, and weigh and balance possible benefits against possible risks of an action. Physicians must refrain from providing ineffective treatments or acting with malice toward patients.  According to the principles of beneficence and nonmaleficence, physicians are obligated to  never harm patients, unless there is a proportional benefit (Jameton). In the case of Means, the hospital risked her life in order to potentially save her unborn child. Does potentially saving her unborn child outweigh the physical and mental harm Means endured?  While a hospital’s first duty is to the mother, as she is the patient, Catholic hospitals may view the lives of both the mother and the unborn child as “compelling interests.”  From the hospital’s religious point of view, the benefits outweigh the risks. However, Means’ perspective was completely ignored, violating her autonomy. Religious hospitals must balance their religious beliefs with the needs of their patients. The physician-patient relationship needs to involve input from both parties, and cannot just rely and what the hospital believes is best for the patient (Adams). 

Religious hospitals may believe that performing operations such as abortions is tantamount to murder (no matter what the circumstances are), and religious hospitals also believe that giving information to patients about treatment options such as abortions is also morally wrong because they become an indirect participant in what they view as the murder of a child. (The National Catholic Bioethics Center).   To physicians at Catholic hospitals, providing information may be viewed as equally immoral to directly providing treatment, as the consequences of both actions are the same. 

Are Catholic hospitals violating their own doctrine by denying treatment/information about lifesaving abortions? Thomas Aquinas is credited with introducing the principle of double effect in his discussion of the permissibility of self-defense in the Summa Theologica. Killing one’s assailant is justified provided one does not intend to kill him. The double effect principle  emphasizes the distinction between causing a morally grave harm as a side effect of pursuing a good end and causing a morally grave harm as a means of pursuing a good end. The New Catholic Encyclopedia provides four conditions for the application of the principle of double effect: The act itself must be morally good or at least indifferent. The agent may not positively will the bad effect but may permit it. If he could attain the good effect without the bad effect he should do so. The bad effect is sometimes said to be indirectly voluntary. The good effect must flow from the action at least as immediately (in the order of causality, though not necessarily in the order of time) as the bad effect. In other words the good effect must be produced directly by the action, not by the bad effect. Otherwise the agent would be using a bad means to a good end, which is never allowed. The good effect must be sufficiently desirable to compensate for the allowing of the bad effect (McIntyre). 

A doctor who believed that abortion was wrong, even in order to save the mother’s life, might nevertheless consistently believe that it would be permissible to perform a hysterectomy on a pregnant woman with cancer. In carrying out the hysterectomy, the doctor would aim to save the woman’s life while merely foreseeing the death of the fetus. Performing an abortion, by contrast, would involve intending to kill the fetus as a means to saving the mother (Shaw). 

Some discussions of double effect wrongly assume that it permits acts that cause certain kinds of harm because those harms were not the agent’s ultimate aim.  The principle of double effect is much more specific than that. Harms that were produced regretfully and only for the sake of producing a good end may be prohibited by double effect because they were brought about as part of the agent’s means to realizing the good end. The principle of double effect does not  apply cases of abortion when the life of the mother is at risk because the agent is using “bad means” (abortion) for a good end (saving the mother’s life).  Under the principle of double effect, abortion can never be permitted; the death of a fetus is only acceptable when it occurs as the side effect of another treatment, not when it is the treatment itself.  The principle of double effect in the case of abortion should focus more on the proportionality aspect, as abortion is ethically ambiguous and is not necessarily a “bad means.” The principle of double effect focuses on both the intentions and the means. A consequentialist approach may be more favorable approach as it focuses more on the intentions than on the means. A consequentialist approach would retain most of the major tenets of the principle of double effect (allowing Catholic hospitals to retain their moral integrity) while also allowing patients to receive best medical care, as the focus is on doing what is best for the patients, regardless of the “means.”

I will discuss some hypothetical situations and treatments such as sterilization to illustrate how different points of view can shift how one sees the value of patient and physician/hospital autonomy. Would a hospital run by Jehovah’s Witnesses be allowed to refuse blood transfusions? While the same principles of patient autonomy and physician/hospital autonomy hold in this scenario, one might be more inclined to support patient autonomy. While a belief in the immorality of blood transfusions is a deeply held religious belief held by Jehovah’s witnesses, this belief is not as respected as the Christian view that abortion is immoral. Allowing even the existence of religious hospitals could lead to a slippery slope. If physician autonomy is valued above patient autonomy, religious hospitals would be able to deny treatments considered uncontroversial by the general public. Do we value one religion more highly than another? Why are the religious beliefs of Catholics considered more valid than those held by Jehovah’s Witnesses? Whose religious beliefs should we respect and not respect, and why? As the American public values some religious beliefs as more valid than others, it is important to note that not all religions can be equally respected. If we cannot accept all religious beliefs in the healthcare system, why should we respect any? It should be noted that blood transfusions are typically seen as “life-saving,” whereas abortions are not usually seen as necessary “treatments.” 

Sterilizations are a practice prohibited by the USCCB which is less “charged” than abortions. By not providing sterilizations, Catholic hospitals do not put a patient’s life in risk. By not providing abortions, a Catholic hospital could potentially cause a patient’s death.  In this scenario one might stand with the physician/hospital’s religious autonomy, as not providing sterilizations does not lead to death. Should the autonomy of a patient change depending on whether or not the situations is life threatening?

I believe that in a life threatening situation, a physician/hospital’s right to conscientiously object does not hold, as a hospital’s first obligation is the health and autonomy of their patients. However, in non life threatening situations, physicians should be able to conscientiously object, as the physician is exercising his/her right to practice his/her religious beliefs while not harming the patient (“Do No Harm”).

Physicians have a right to conscientiously object to any treatment which they view as morally wrong. Does conscientious objection apply to physicians not giving patients information about potentially lifesaving treatment options? Is there a difference between refusing to perform an abortion and refusing to give a patient information about this treatment option? Giving information to a patient makes a physician an “indirect participant”  in what they believe is the murder of a child (Rasinski). While the physician does not actually perform the abortion, the consequence of providing information to a patient is the same as performing an abortion on the patient (Pellegrino). However, when the mother’s life is at risk, physicians should be obligated to give information, as the consequences of this action are good, and the physician did not perform a direct “bad” action. 

Can a Hospital Have the Same Religious Freedom as an Individual? In order to explore the ethical issues raised by this question, we must explore the legislation which allows Catholic hospitals to function as they do.  

In Employment Division v. Smith (1990), two American Indians who worked as private drug rehab counselors ingested peyote as part of religious ceremonies conducted by the Native American Church, and they were subsequently fired. The U.S. Supreme Court upheld the firing.   A near unanimous Congress passed RFRA in 1993 and President Bill Clinton signed the law. RFRA said that “governments should not substantially burden religious exercise without compelling justification” and “the compelling interest test as set forth in prior Federal court rulings is a workable test for striking sensible balances between religious liberty and competing prior governmental interests.” The compelling interest test dates back to another Supreme Court decision, Sherbert v. Verner, from 1963.  The Sherbert test said that if a person claimed a sincere religious belief, and a government action placed a substantial burden on that belief, the government needed to prove a compelling state interest (HHS). 

The case of Burwell v. Hobby Lobby Stores Inc. is a prime example of the application of the Religious Freedom Restoration Act of 1993 to corporations. The Green family owns and operates Hobby Lobby Stores, Inc., a national arts and crafts chain with over 500 stores and over 13,000 employees. The Green family has organized the business around the principles of the Christian faith and has explicitly expressed the desire to run the company according to Biblical precepts, one of which is the belief that the use of contraception is immoral. Under the Patient Protection and Affordable Care Act (ACA), employment-based group health care plans must provide certain types of preventative care, such as FDA-approved contraceptive methods. While there are exemptions available for religious employers and non-profit religious institutions, there are no exemptions available for for-profit institutions such as Hobby Lobby Stores, Inc. On September 12, 2012, the Greens, as representatives of Hobby Lobby Stores, Inc., sued Kathleen Sebelius, the Secretary of the Department of Health and Human Services, and challenged the contraception requirement.  The plaintiffs argued that the requirement that the employment-based group healthcare plan cover contraception violated the Free Exercise Clause of the First Amendment and the Religious Freedom Restoration Act of 1993 (The Hobby Lobby Case). Does the Religious Freedom Restoration Act of 1993 allow a for-profit company to deny its employees health coverage of contraception to which the employees would otherwise be entitled based on the religious objections of the company’s owners? In a 5-4 majority,  the Court held that Congress intended for the RFRA to be read as applying to corporations since they are composed of individuals who use them to achieve desired ends. Because the contraception requirement forces religious corporations to fund what they consider abortion, which goes against their stated religious principles, it creates a substantial burden that is not the least restrictive method of satisfying the government’s interests. In his concurrence, Justice Anthony M. Kennedy wrote that the government had not met its burden to show that there was a meaningful difference between non-profit religious institutions and for-profit religious corporations under the RFRA.  Justice Ruth Bader Ginsburg wrote a dissent in which she argued that religious beliefs or observances must not impinge on the rights of third parties, as the sought-after exemption would do to women seeking contraception in this case (Marshall). 

Should non-profits  have “religious exemptions?” According to legal precedence and the RFRA of 1993, nonprofits and closely held corporations have the legal right to conscientiously object on the basis of strongly held religious beliefs. In the case of  Catholic hospitals (most of which are nonprofit corporations), individuals within the corporation should not be forced forced to perform abortions. However, if individuals within the corporation are willing to perform abortions in extraordinary cases, they should be able to, as the individuals which make up the corporation have different beliefs and different “desired ends” then the entity which owns the corporation (White). While nonprofits should have religious exemptions, their religious exemptions should not be able to cause grave harm to a third party. However, protecting the life of a woman and the life of the fetus are both “compelling state interests” to the government. The hospital and its physicians may also experience the same conflict of interest. Therefore, a Catholic hospital’s religious exemption status should not allow them to deny information from patients, as this mitigates the conflict of interest between protecting the mother and protecting the fetus.  It’s also interesting to consider that the role of hospitals is to provide best medical practice for their patients. In some circumstances, this might include abortions and sterilizations as life-saving treatments for women. This defining function may be at odds with the RFRA.  

Various pieces of  legislation known as “conscience clause legislation” allow Catholic hospitals to refuse treatment/information to patients regarding treatments such as abortion, sterilization, and other practices.  The 1973 Public Health Service Act (the “Church amendment”) declares that hospitals or individuals’ receipt of federal funds in various health programs will not require them to participate in abortion and sterilization procedures, if they object based on moral or religious convictions. It also forbids hospitals in these programs to make willingness or unwillingness to perform these procedures a condition of employment.  Another provision protects the general conscience rights of individuals in federally funded health service programs. A final provision prohibits entities that receive public health service funds from discriminating against applicants who decline to participate in abortions or sterilizations on account of religious beliefs or moral convictions. The 1974 Legal Services Corporation on abortion prohibits Legal Services Corporation funds from being used to compel involvement in abortion. The 1988 Civil Rights Restoration Act prohibits construing a federal sex discrimination provision [Title IX of the Education Amendments of 1972] to require an educational entity to violate its religious tenets, or to pay for or provide abortion or abortion benefits. The 1996 Protecting health care entities that decline involvement in abortions for any reason prohibits the federal government and state and local governments receiving federal funds from discriminating against health care entities (including residency programs) and individual health care providers that do not provide, train in or refer for abortions. 1997 Medicare: counseling and referral prohibits construing the Medicare statute to require Medicare + Choice managed care plans to provide counseling and referral services to which they have a moral or religious objection. The 2004 Hyde/Weldon Conscience Protection Amendment protects physicians and nurses, hospitals, health insurance companies, and other healthcare entities from being forced by state or federal governments to perform, pay for, provide coverage of, or refer for abortions. The Hyde/Weldon Amendment has been approved every year since 2004. The Affordable Care Act includes new health care provider conscience protections. Section 1303(b)(4) of the Act provides that “No qualified health plan offered through an Exchange may discriminate against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions” (Congress). 

Both physicians and patients have a right to their autonomy and how in Catholic hospitals, the physician-patient relationship is often skewed towards a paternalistic view rather than a “patient autonomy” view.  How can Catholic hospitals create balance in the physician-patient relationship?

Twelve percent of hospitals in the United States are affiliated with the Catholic Church. Women like Means may not have access to secular hospitals. MHP (a Catholic hospital) is the only hospital in Means’ county. What can be done about the issue of equity and the fact that many women do not have access to secular hospitals, and therefore do not have access to treatments and procedures they need/want?  As Catholic hospitals are private organizations, the government cannot regulate them in terms of services they do and do not provide.  Also the government cannot limit their Constitutional right to freedom of religion. (Catholics for Choice) The government should try to ensure that people like Means have access to secular hospitals so that they can receive the treatment they want/need. It is unethical that women like Means do not have access to lifesaving and futile treatment options while other women do. Since most Catholic hospitals are located in rural areas (many Catholic hospitals exist as community health centers which assist the poor), women without the financial means to access healthcare from a secular hospital are forced to rely on services provided by Catholic affiliated health clinics. The government should encourage more secular organizations to create free community health clinics for the poor. 

While Catholic hospitals have a right to their autonomy, they do not have a right to take away the autonomy of their patients. Catholic hospitals are not obligated to perform treatments such as abortions or sterilizations, but they are obligated to inform patients of all their treatment options. Hospitals are not forced to do anything which directly clashes with their moral beliefs, and the sanctity of patient autonomy is maintained. However, when a patient’s life is in immediate risk, a physician/hospital’s obligation to protect the life of the patient trumps their conscientious objection. 

The government should encourage secular organizations to create free community health clinics for the poor. Organizations such as Planned Parenthood (which receives government funding) should attempt increasing their presence in rural areas. The government should ensure that all secular community health clinics and hospitals are prepared to provide a full range of reproductive health services to women. The Wisconsin Senate recently passed a bill to cut Planned Parenthood’s federal funding. Many states have laws which restrict women from getting access to abortion, regardless of socioeconomic status. An upcoming Supreme Court case from Texas has the potential to significantly deteriorate Roe v. Wade, and it is possible that abortion may become illegal as it was before 1973. If this were to happen, legislation should exist which allows women to receive abortions if their life is in danger and in cases of rape or incest. Even in an environment where abortion was illegal in the United States, Catholic hospitals should still be required to provide information about abortion services to women whose lives are in danger. 

While access is a major issue for poor women in rural areas, another major issue for poor women is lack of health insurance. Lack of health insurance force women to completely rely on free community health clinics/hospitals (most of which are Catholic). The government should focus on making sure every person has health insurance, and that Medicaid (which covers abortion in only 15 states) should cover abortion in every state. Women who rely on Medicaid fall on or below the poverty line. Even with health insurance, they do not have access to potentially life saving abortions. This area of discussion deserves further inquiry, beyond the scope of the paper. 

Individuals should not be forced to perform abortions or provide information. Hospitals, however should be required to perform abortions (if medically necessary) and provide information. Individual physician autonomy should not be infringed upon. However a corporation should not be able to prevent physicians from performing abortions or information if a woman’s life is in danger. All existing conscience clause legislation should stand, except for the Hyde/Weldon Amendment which should be revised by Congress in order to create an exception for women whose lives are in danger. 

Legislative reform is critical. Health insurance, conscience clause legislation, and access to abortion providers are issues which need to be addressed by the government. Because Catholic hospitals have an ethical right to abstain from performing abortions (unless the situation is immediate), the government needs to step in in order to protect women as well as Catholic hospitals. If women whose lives were at risk had greater access, Catholic hospitals would be better able to maintain their autonomy and values, as they would not be forced into a situation which would require them to do something “immoral.” In an ideal situation, legislative reform and greater access to secular hospitals would mitigate the problem of Catholic hospitals refusing treatment/information. However, in reality, the inclusion of secular hospitals may or may not mitigate the situation, depending on the state. For example, in Texas there is only one provider of abortion services. Even if a woman living in a rural area in Texas where there is only a Catholic hospital is in need of a lifesaving hospital, going to a secular hospital would not give her access to the abortion she needs. In a state like NY this situation would play out  differently, as access to a secular hospital could very well save the woman’s life. 

Women’s reproductive rights and an individual/hospital’s religious freedom should and can coexist with pointed legislative effort.