The Problem
• Reproductive health care services for millions of Americans are being
lost, restricted and denied at a steady rate due to 1) a flood of state refusal
clauses and federal policies, 2) hospitals and insurers that must observe
sectarian religious directives, and 3) refusals by individual providers and
dispensers
• The implications for patients are enormous: They are denied treatment
or medication even when it is legal and they can pay for it
• Refusals are affecting an expanding number of health care services,
including infertility care and end-of-life care
State Refusal Clauses
• 46 states allow individual health care providers to refuse to provide
abortion services
• 43 of these states allow health care institutions to refuse to provide
abortion services
• 13 states allow some health care providers to refuse to provide services
related to contraception
• 17 states allow some health care providers to refuse to provide sterilization
services
• A few states have enacted laws that specifically allow pharmacies
or pharmacists to refuse to fill legal prescriptions due to religious or moral
objections. Several other states have broadly worded statutes that might protect
pharmacists or pharmacies from liability for the refusal
Federal Ban
The Hyde-Weldon Conscience Protection Amendment was signed into law in December
2004 as part of the 2005 appropriation for Health and Human Services. The
effect of this legislation is to prevent federal, state and local governments
from requiring health care entities to provide or pay for certain abortion-related
services (those funded under the Labor/HHS appropriations bill). While previous
law protected individual health care providers and medical training programs
that refused to provide abortion services or training, the new provision also
allows large health insurance companies and HMOs to refuse to provide coverage
or pay for abortions without reprisals, thus potentially affecting a much
larger number of patients. The amendment must be renewed annually and is currently
being challenged in California.
Hospital Restrictions
• Catholic hospitals constitute the largest single group of nonprofit
hospitals in the U.S., with over 11% of the nation’s total community
hospitals and 16.2% of the nation’s total community hospital beds
• One in five Americans receives health care in a Catholic affiliated
institution
• All Catholic Hospitals operate under the Catholic Church’s Ethical
and Religious Directives for Health Care. The Directives prohibit the provision
of abortion, contraception, emergency contraception, voluntary sterilization,
and assistive reproductive procedures such as in vitro fertilization in Catholic
Church-affiliated hospitals, clinics, out-patient facilities, universities,
health management organizations (HMOs), social service agencies, urgent care
centers, hospices, and nursing homes
• Since the mid-1990s, more than 135 business partnerships have been
instituted by Catholic and non-Catholic institutions in which the church’s
restrictions have been applied
Physician Attitudes
A University of Chicago study of physicians’ attitudes correlated with
religion found that:
• 14% of physicians surveyed believe it is acceptable to withhold medical
options they find morally objectionable
• 29% of physicians would not refer a patient for a procedure to which
they object
• The more religious a physician was in the survey, the more likely
they were to object to providing certain services and the less likely they
were to inform patients about other options, or provide referral to another
care provider who did not share their objections
The study authors concluded that:
• Anywhere from 40 to 100 million Americans are being cared for by physicians
who place their own views above the needs of their patients
Examples of refusals include:
• Healthcare professionals refused to provide information to cancer
patients who asked about harvesting an egg or a sperm
• Pregnant patients were denied sterilization procedures at religiously
affiliated hospitals
• Terminal ill patients were denied pain medications in end-of-life
situations
• Rape victims were denied information about emergency contraception
pills
Legal situations:
• An ambulance worker in suburban Chicago sued a company that had purportedly
fired her for refusing to transport a patient suffering severe abdominal pain
to a clinic for an abortion
• An Illinois county settled a lawsuit brought by an employee denied
a promotion purportedly because she refused to translate into Spanish information
for family planning clients on abortion options
• A Wisconsin pharmacist faced a disciplinary hearing for refusing to
transfer a woman's prescription for oral contraceptives to another pharmacy
