Lack of transparency in disclosure of hospital religious affiliations and subsequent healthcare restrictions greatly inconveniences patients, according to a recent letter published in JAMA.

In 2016, 14.5% of US hospitals were Catholic, and between 2001 and 2011, the number of Catholic hospitals increased by 16%. The US Conference of Catholic Bishops expects these hospitals to follow the Ethical and Religious Directives for Catholic Health Care Services (the directives), which may result in patient care being influenced by the tenets of the Catholic church.

This prospective, observational study analyzed the website information of all hospitals listed in the Catholic Healthcare Directory from July 2017 to January 2018. Study investigators used a structured data abstraction form to analyze the home pages, “about us” pages, and mission statements to understand the religious affiliation of the hospitals. They also searched for keywords, including “ethic,” “directives,” “limit,” “service,” and “abortion” to understand the potential restrictions in patient care.

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Among the 646 hospitals thus analyzed, 79% disclosed their religious identity on their website and 24% cited the directives on their website. Among the 494 hospitals that did not cite the directives, 28 reported end of life care restrictions and 8 reproductive care restrictions.

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Limitations to this study include that hospitals studied were limited to the ones listed in the Catholic directory. Some may not have been listed or might have changed ownership. Also, other treatment-related disclosures may have been missed in this study due to the search terms used. Further, the hospitals not citing the directives may not be adhering or there might be a transparency issue, and some hospitals may only partially adhere to the directives.

The study investigators advised that transparency about religious affiliations and subsequent treatment restrictions may help patients make an informed decision in choosing hospitals. If patients and families are unaware of a hospital’s restrictions, refusal or delay in care due to the necessity to shift to another hospital may result in increased risks and unnecessary expenditures. Further research on the effect of such disclosures on care choices and patient satisfaction may reveal the effectiveness of such a measure.


Takahashi J, Cher A, Sheeder J, Teal S, Guiahi M. Disclosure of religious identity and health care practices on Catholic hospital websites. JAMA. 2019; 321(11):1103-4. doi: 10.1001/jama.2019.0133