Dangerous Abortion Refusal Clause Included in House Bill.

The amendment would forbid state or local governments from requiring any individual or institution to perform, provide, or even refer for an abortion under any circumstances.

On September 9, the U.S. House of Representatives passed the Weldon amendment as part of the Labor-Health and Human Services-Education Appropriations bill. This amendment would forbid state or local governments from requiring any individual or institution to perform, provide, or even refer for an abortion under any circumstances. This means that any health care professional or hospital (not just religiously affiliated facilities) could refuse to perform, refer, or even counsel a woman about abortion, even if the woman requests the information or if such information could protect her health.

The Senate’s version of the Appropriations bill does not include the Weldon amendment. Before the bill can become law, a conference committee will meet to work out the two bills’ differences. The Weldon amendment could remain in the final version of the bill.

What Are Refusal Clauses?

Refusal clauses originally allowed individuals and hospitals to refuse certain reproductive health services to patients based on personal belief or institutional ideology. Congress enacted the first refusal clause in 1973 after the U.S. Supreme Court’s decision Roe v Wade recognized a woman’s right to have an abortion. The clause allowed doctors, other direct care providers such as nurses, or hospitals “to refuse to provide abortion and sterilization services based on moral or religious convictions.”

Thus, many women are denied full information regarding reproductive health care choices and access to services. They are not told about their legal right to have an abortion or are not allowed to have a tubal ligation (sterilization) at the same hospital that delivers their baby.

Unlike earlier refusal clauses which were limited to direct service providers and focused mostly on abortion services, more recent refusal clauses allow indirect providers such as HMOs, health insurance plans, and entire health care systems the right to deny patients care. Additionally, the exemptions have broadened to include all types of reproductive health care services, including contraception, in vitro fertilization, and emergency contraception (EC). Furthermore, these entities can deny services for any reason, not just those of conscience. Clauses, like the Weldon amendment, are also broadening their scope to include referrals, counseling, or even the mention of all legal options for patients.

Refusal Clauses Threaten Access to Prescriptions

While pharmacists have always had the right not to participate in an abortion, there is a growing movement to expand refusal clauses to allow pharmacists to refuse to fill prescriptions for medications that have nothing to do with abortion. And there are increasing reports of pharmacists refusing to fill prescriptions for birth control. “I personally don’t believe in birth control and therefore I’m not going to fill your prescription”; “I don’t think you should have it [emergency contraception]”; “I believe emergency contraception ends a life.” Women are beginning to hear these statements as they attempt to fill their doctor’s prescriptions.

Representative Frank Corte filed a bill (HB 16) in the Texas House that would specifically allow pharmacists and pharmacies to refuse to “directly or indirectly dispense or participate in the dispensing of” emergency contraception. The Legislature will take it up when the session starts in January.

Pharmacists Refusing Prescriptions for North Texas Women
This past January an Eckerd’s pharmacist in Denton refused to fill a rape victim’s prescription for EC, even though the Eckerd’s had EC in stock. The pharmacist thought she should not have it. The woman had to try three pharmacies before she eventually received the medication. Then in March a CVS pharmacist in North Richland Hills refused to fill a young mother’s prescription for birth control pills, a prescription the woman had previously filled at the pharmacy without trouble.

Pharmacists are not only refusing to fill prescriptions for birth control. This past summer a Dallas pharmacist would not fill a mother’s prescription for her son’s Ritalin. Ritalin is an FDA-approved drug taken by children who have Attention Deficit Disorder. The pharmacist did not believe children should take the medication.

Refusal Clauses Limit Access to Health Care

Refusal clauses limit the number of health care providers women can see for family planning services. In rural communities there may not be a doctor on the insurance plan who prescribes birth control or the local pharmacy may refuse to stock contraception. Even in cities, access to care is limited. Your health insurance plan may only provide coverage at two hospitals—neither of which will perform tubal ligations. No one should be denied access to basic health services by individuals or institutions that choose to impose their own ideological beliefs on others.

Recent refusal clauses also affect access to a range of health care practices and services, because they allow any health care entity to refuse medical care, information, and referrals—for any reason. Under existing law, health care providers have an obligation to share with patients all relevant information about their health care choices, even if they do not want to provide the service. Current refusal clauses deny patients even that right.

Any health insurance company could be exempt from covering FDA-approved contraceptives. Pharmacists could be exempt from even referring women to another pharmacy to fill a birth control prescription. Hospital emergency rooms could refuse to comply with laws requiring them to provide emergency contraception to rape victims. Expanding refusal clauses is a slippery slope to allowing refusal for any procedure or medication a health care professional does not agree with or an insurer does not want to pay for.

Currently, nine states allow individual health care providers to refuse to provide or dispense contraception. Most recently, Mississippi enacted the broadest refusal clause in the country, allowing “health care providers—including pharmacists or other pharmacy employees, counselors, social workers, health insurers and health care facilities—to refuse to provide [any] medical services, including counseling and referral, on religious or ethical grounds.” Nine other states introduced, but did not pass, similar legislation in 2004.

Who Decides?
It is important that individuals retain the right to conscientious objection, but it is also important that patients’ rights to health care and conscience are protected. Refusal clauses deny patients the right to make their own decisions about which medications or procedures are appropriate. They deny patients the right to make medical decisions based on their religious beliefs, rather than those of their hospital or health insurance plan. This is unacceptable.

Physicians, pharmacists, other direct care providers, and health care organizations have a duty to see that patients receive care. All refusal clauses should include mechanisms for ensuring that patients receive information on all of their medical options, are given referrals as necessary, and are not required to travel extreme distances to obtain basic health care.

Author: Planned Parenthood

News Service: Planned Parenthood

URL: http://www.ppnt.org/default.asp?pageid=1177