Broader conscience clauses would expand physicians' right of refusal

A new push in state legislatures to pass very broad conscience laws is giving many physicians pause.

By Kevin B. O'Reilly, AMNews staff. March 6, 2006.

Legislators in at least nine states this year have proposed sweeping legislation granting physicians and other health professionals the right to refuse to provide any medical service on the grounds of conscience, without fear of firing, discipline or liability. The proposed legislation also would give hospitals and third-party payers the same conscience rights.

Many state medical societies long have supported the concept of conscience clause laws when they have been related to abortion and other controversial services. However, societies in several of the states where legislation is pending are either neutral or speaking out against the push to extend the principle more broadly.

The bills, which are based primarily on a model crafted by the conservative Chicago-based Americans United for Life, are one aspect of the larger debate over how best to balance health professionals' conscience rights and patients' access to care. That debate has heated up recently after some pharmacists refused to fill prescriptions for the emergency contraceptive pill, also known as Plan B or the morning-after pill, because they believe it is a form of abortion.

If bills pending in Alabama, Michigan, Missouri, Rhode Island, Tennessee, Vermont, Washington and West Virginia pass, the controversy might only deepen. A similar measure narrowly failed in South Dakota last month.

"The legislation that's on the books mostly protects physicians who don't want to perform abortions," said David Stevens, MD, executive director of the Christian Medical & Dental Assns., which supports the expanded laws that are being referred to as "health care rights of conscience acts." "Very little of it protects other types of health care workers with regard to the morning-after pill and other new technologies in the pipeline."