Seyfarth Synopsis: With the myriad claims for religious accommodation that came out of mandatory COVID vaccination policies, employers have become familiar how to handle requests for religious accommodation in the workplace.  However, healthcare employers face unique challenges when it comes to request for religious accommodation from healthcare providers who refuse to provide certain treatments or perform other duties based on religious objections.  These challenges lie at a complex intersection between employment and healthcare law.

Consider the following scenarios:

• A nurse at a hospital has a religious objection to participating in abortion procedures.
• A healthcare provider who is a Jehovah’s Witness refuses to administer blood transfusions.
• A physician at a family planning clinic refuses to prescribe contraceptives due to religious beliefs.
• A fertility doctor refuses to perform artificial insemination for a patient based on the patient’s sexual orientation or marital status.
• A receptionist at a doctor’s office objects to scheduling appointments for procedures like vasectomies on religious grounds.

Employers who confront these scenarios in the workplace must consider federal and state legal protections for healthcare providers who have conscience or religious objections to providing certain treatments.  There are compliance obligations under Title VII, which requires employers to accommodate the religious beliefs of their employees absent undue hardship, as well as the separate laws allowing conscience and religious objections that specifically protected healthcare workers.  These compliance obligations must be balanced against the employer’s duties to its patients, which includes a duty not to discriminate in the provision of healthcare services. 

Federal and State Legal Protections for Conscience and Religious Objections of Healthcare Providers

Healthcare providers who object to performing their duties on the basis of religion can avail themselves of various federal and state laws that protect health care workers who refuse to participate in certain medical procedures due to conscience or religious objections. For example, the Church Amendments, 42. U.S.C. § 300a-7, and the Coats-Snowe Amendment, 42 U.S.C. 238n, provide express federal protections for healthcare workers who object to participating in procedures such as abortions or sterilizations at federally-funded healthcare organizations.  Some states also have specific laws providing protections for healthcare workers with such objections.

Moreover, even though the Church amendments focus on objections to abortion and sterilization, they also contain a provision that generally prohibits a health care provider from requiring an employee to perform a service for which they claim a moral or religious objection.  Even though this provision appears in a section entitled “Sterilization or abortion,” OCR relies on this “catch all” provision as a justification for policing a wider range of religious and conscience objections by healthcare providers that go beyond abortion and sterilization.  

In January 2024, the Department of Health and Human Services implemented a final rule entitled “Safeguarding the Rights of Conscience as Protected by Federal Statutes.”  This rule clarifies the process for enforcing the protections provided under the Church Amendment laws and strengthens protections prohibiting discrimination against health care providers with conscience and religious objections.  Although OCR has stated it will take into account the operational impact on healthcare employers of accommodating religious and conscience objections (noting that the conscience statutes “co-exist with others protecting rights of access to health care”), the final rule does not articulate a specific standard.  One could argue it would be logical to impute the reasonable accommodation standards found in other anti-discrimination laws, but neither OCR nor any other legal source have explicitly supported that approach.

An Employer’s Duty to Accommodate Employee Religious Beliefs

Healthcare providers who object to performing any of their duties for religious reasons also have protections under Title VII of the Civil Rights Act of 1964 and its state law equivalents, which prohibit employment discrimination based on religion.  These laws generally require employers to reasonably accommodate an employee’s religious beliefs or practices, unless doing so would cause undue hardship on the operation of the employer’s business.

Healthcare Organizations Non-Discrimination Obligations to Patients Under Federal Law

To make matters more complicated for employers considering religious and consciences objections that healthcare providers have to performing patient-facing duties, hospitals have independent obligations under federal law not to discriminate against patients in the provision of health care services.  Under Section 1557 of the Affordable Care Act, hospitals are prohibited from discriminating on the basis of race, color, national origin, sex, age or disability in their health care programs or activities. 

Balancing Accommodations and Operational Needs

When faced with religious objections from health care providers, employers must carefully balance the need to accommodate a provider’s religious beliefs with their duty not to discriminate against patients and the operational requirements of their healthcare facilities. 

From a Title VII perspective, the employer can deny a request for religious accommodation if the accommodation presents an undue hardship.  Employers denying requests for religious accommodation on undue hardship grounds under Title VII must show that the cost to their business of accommodating a request for religious accommodation would be excessive or unjustifiable.  To the extent a healthcare provider is refusing to provide a treatment that must then be provided by a co-worker, in order to demonstrate undue hardship, an employer must show how the accommodation’s impact on other employees would substantially affect the conduct of its business.  In terms of federal healthcare protections, an employer could theoretically apply the Title VII undue hardship standard to accommodations requested by healthcare workers who may also have certain rights under conscience laws since it presents a high bar, but an employer must do so with the awareness that OCR has not been transparent about what standard it will apply when reviewing complaints from healthcare providers who believe they have been wrongly denied religious accommodation.

If an employer grants a religious accommodation, it should be thoughtful and transparent in conversations with the employee with the religious objection about how that employee will decline to provide the services to which the employee objects on religious grounds.  If not handled correctly, the declination could lead to claims of discrimination by a patient or hurt the employer’s reputation among the communities it serves.

Conclusion

Handling religious objections from health care providers requires a nuanced approach. Healthcare providers and institutions should ensure they understand and comply with all applicable laws.  By understanding the legal framework and considering practical effect of accommodations, healthcare employers can respect their employees’ beliefs while ensuring that patient care remains uncompromised. Employers should also consult with legal counsel and regularly review policies and procedures can help maintain compliance and protect both employees’ rights and the institution’s interests and train managers on these policies and procedures.