Wisconsin "conscience clause" bill gets rapped as bad policy

The state medical society opposes the bill allowing doctors to opt out of certain procedures because it doesn't require a referral to another physician.

By Andis Robeznieks, amednews staff. Aug. 4, 2003.

A "conscience clause" bill passed by the lower house of the Wisconsin Legislature would go further than an existing law which allows health care professionals to opt out of participating in abortions and sterilization procedures, and it would extend the right to refuse into such arenas as embryonic stem cell research and end-of-life care.

The National Abortion and Reproductive Rights Action League reports that 45 states have some sort of "refusal clause" allowing medical personnel to opt out of participating in abortions.

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What troubles opponents of the Wisconsin bill is that it doesn't require physicians to refer patients to another doctor and that it may lead to access-to-care problems for patients in small communities.

Mark Grapentine, Wisconsin Medical Society legislative counsel, said that the debate has almost become a law school seminar where participants debate "what-could-happen ifs," but he said the way the bill is written invites unintended consequences, especially in end-of-life care.

One particular concern is that the bill would allow physicians to refuse to withdraw feeding tubes from a terminally ill patient even if that patient's advance-care directive or living will calls for them to be withdrawn.

And that's especially troubling to some end-of-life care groups.

45 states allow medical personnel to opt out of participating in abortions.

"We are absolutely opposed to not following a patient's wishes," said Melanie G. Ramey, executive director of the Hospice Organization and Palliative Experts of Wisconsin. "They [bill supporters] have been antsing and dancing around trying to explain what it says, but we can read English."

Grapentine said the medical society would just as soon avoid getting into a debate on abortion but, because of the issue of referral, he said the organization opposes the bill and is working to remove the non-referral clause.

In a memo to legislators, the WMS stated its support for the existing law, which mandates that refusing physicians must refer patients to a doctor who will provide the desired care. "This is an ethical standard that all physicians must follow," the memo stated, adding that the bill "creates bad policy and exposes ill patients who are most vulnerable to an inability to receive the care that the patient desires."

"Continuity of care is a very basic quality issue in medicine," said Michael S. Goldrich, MD, chair of the AMA Council on Ethical and Judicial Affairs. "To not assure transfer of care and records is not generally within the guidelines and code of ethics for standards of care."

The American College of Obstetricians and Gynecologists' ethical policy provides for instances when a doctor can refuse to perform a procedure, but it also calls for the refusing physician to make a referral.

Wisconsin's Assembly passed the bill by a 56-35 vote, and the state Senate is expected to pick up the debate in September.

Unlike Washington state and Virginia, where similarly introduced conscience clause bills expired, Wisconsin's bill remains active despite the lack of Senate action.

One of the bill's chief opponents, state Rep. Terese Berceau, said that the bill's broad language could be interpreted in such a way that health care professionals could avoid performing an amniocentesis because there is a small chance of causing a miscarriage (somewhere between one in 200 and one in 400, according to the March of Dimes).

Supporters -- such as Barbara Lyons, executive director for Wisconsin Right to Life -- disagree, and say opponents are "looking at hypothetical situations that don't exist."