Religious Accommodation in the Healthcare Industry: What to Do When an Employee’s Beliefs Clash With Job Duties

Title VII of the Civil Rights Act of 1964 prohibits employers from discriminating against applicants and employees based on their religion, and requires employers to provide a reasonable accommodation of employees’ sincerely held religious beliefs. State laws provide employees and applicants with similar protections of their religious beliefs.

The most common requests for accommodations based on religious beliefs relate to scheduling issues and dress code variations. Healthcare employers may face other unique accommodation requests, such as requests:

• to decline mandatory vaccinations;
• to refuse to perform or participate in certain medical procedures; and
• to refuse to dispense or administer certain medications.

This article provides an overview of the unique challenges that healthcare employers face when confronted with employee requests for reasonable accommodation of their religious beliefs.

General Legal Principles for Accommodating Religious Beliefs

An employer has an obligation to provide a reasonable accommodation of its employees’ sincerely held religious beliefs, observances and practices, unless the accommodation would cause the employer to suffer an undue hardship.  

An employee may need an accommodation if his or her religious beliefs conflict with job requirements. It is the employee’s responsibility to notify the employer that he or she needs an accommodation and to initiate the discussion of how the employer can accommodate the employee while the employee continues to accomplish the work he or she was hired to perform.

Once the employee notifies the employer of the need for an accommodation, the employer may and should obtain more information to make sure it has a complete understanding of the situation, including, for example a description of the religious belief and the source of the belief, details regarding the specifics of the restrictions entailed, and an understanding of exactly what accommodation the employee is requesting to resolve the conflict between the religious belief and the work requirement. If the requested accommodation can be provided without causing undue hardship—defined as more than a de minimis cost or burden—then the employer may provide the accommodation requested by the employee.

Alternatively, the employer may work to identify other ways to accommodate the employee and resolve the conflict. The employer is not required to agree to the specific accommodation requested by the employee; the important thing is that the employer provides an accommodation that resolves the conflict, if possible.

Special Considerations in Healthcare 

Vaccinations

One frequent topic of concern for healthcare providers is that of employees who do not want to submit to required vaccinations. In a letter dated March 5, 2012, the U.S. Equal Employment Opportunity Commission (EEOC) issued guidance for situations in which an employee objects to being vaccinated on religious grounds. The guidance stated that an employer may be required to exempt an employee from a vaccination requirement based on the employee’s religious beliefs—unless that exemption would expose the employer to an undue hardship. In order to assess whether it is appropriate to provide the requested vaccination exemption, the employer will need to consider a number of factors, including the potential risk posed by employing a worker in a health care setting who is not vaccinated, the availability of other means of disease control, and the number of employees seeking an exemption. 

Medical Procedures

Another frequent issue is that of employees who object on religious grounds to participating in medical procedures such as abortions, sterilizations, in vitro fertilizations, or stem cell procedures, to name a few. As with other requests for religious accommodation, how an employer addresses these objections—and whether an employer can agree that a healthcare employee will not be required to participate in one of the procedures at issue—will depend on a variety of factors.  One consideration is the size of the healthcare provider and the particular department in which the employee works. For instance, a facility or department with only a few healthcare providers on duty at a given time may not be able to allow one of those employees to step back from a necessary medical procedure. One option in this situation which is specifically identified in the EEOC’s guidance could be to transfer the employee to a department where the medical procedure will not be an issue. In the EEOC’s example, it would be permissible for an employer to transfer a nurse who objects to certain procedures (such as abortions) from the labor and delivery unit to the newborn intensive care unit, where the procedure would not be an issue.

Medications

Finally, healthcare employers may have to deal with situations in which employees object to dispensing or administering medications, such as birth control pills, “morning-after” contraceptive pills, and the like. If the employer can provide the requested accommodation and still be sure that patients will receive the needed medication and related information, then it may agree to the accommodation. However, the accommodation may need to include a requirement that the employee with the religious belief refer the patient to another employee who is also qualified to provide the medication and information. The employee should not be allowed to interfere with the patient’s receipt of the medication and care or otherwise ignore the patient’s needs.

Conclusion

The paramount consideration for any healthcare employer is the health and wellness of its patients—as it should be. However, healthcare employers also have an obligation to provide a reasonable accommodation of their employees’ sincerely held religious beliefs, as long as the accommodation will not cause the employer to suffer an undue hardship. An employer faced with a request for a reasonable accommodation should take the time to understand the employee’s needs, adequately assess the employee’s request, consider potential alternatives to the employee’s requests, and make a decision that either resolves the employee’s conflict or is supported by articulable facts showing undue hardship.