Battle of the conscience clause: When practitioners say no

When do medical professionals have the right to opt out of treating patients?

By Andis Robeznieks, AMNews staff. April 11, 2005.

Pharmacist Neil Noesen refused to fill a prescription for contraceptives while working at a retail pharmacy in Menomonie, Wis., and then refused to transfer the prescription to another pharmacist. His actions have helped keep politicians, lobbyists and some medical societies very busy.

Repercussions from Noesen's actions have included a reprimand from an administrative law judge Feb. 28 and an order to take a six-hour course in pharmacy ethics. The case also has served as a rallying cry for supporters of new conscience-clause laws that allow health care professionals to refuse to participate in procedures they say violate their religious and moral principles.

Last year, 23 states considered legislation to expand conscience-clause laws pertaining to the refusal of individuals or entities in health care to refuse to provide services related to abortion or contraception. Few, however, passed. So far this year, four states have introduced laws that expand the list of services that physicians would be allowed to opt out of.

Conscience-clause laws came into vogue after the Supreme Court's 1973 Roe v. Wade decision struck down state laws against abortion. Since then, 47 states have passed conscience clauses that pertain mostly to health care professionals being allowed to opt out of performing abortions or sterilization procedures.

New proposals, however, expand this list to include the right to refuse to follow a patients' advance directives for end-of-life care, to prescribe or dispense contraceptives, to assist in a suicide, and to conduct embryonic stem cell research or use future treatments derived from that research.