"Conscience" clauses: Clear?

Could your doc refuse to even refer you to someone who'll prescribe you the Pill?

By Lynn Harris

Published April 9, 2008 2:20PM (EDT)

We've talked, and not in glowing terms, about pharmacists who refuse to fill prescriptions for contraception, emergency and otherwise. And also, perhaps more to the point, about pharmacies that refuse to put an acceptable-to-all "conscience" policy in place (plus states that are trying, disingenuously, to protect them). But what about doctors who refuse to provide those prescriptions -- or even to perform abortions? Where do we draw that line between following one's "conscience" and doing one's job?

The American College of Obstetricians and Gynecologists can tell you exactly. From its November 2007 policy statement:

"Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient's health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities. Conscientious refusals that conflict with patient well-being should be accommodated only if the primary duty to the patient can be fulfilled. All health care providers must provide accurate and unbiased information so that patients can make informed decisions. Where conscience implores physicians to deviate from standard practices, they must provide potential patients with accurate and prior notice of their personal moral commitments. Physicians and other health care providers have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. In resource-poor areas, access to safe and legal reproductive services should be maintained. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient's physical or mental health, providers have an obligation to provide medically indicated and requested care."

Done. Or ... not. According to the American Medical News, that statement is now, eye roll, under fire from U.S. Health and Human Services Secretary Michael Leavitt. Leavitt's concern, shared by antiabortion OB-GYNs (led by Joe DeCook, vice president of the American Association of Pro-Life Obstetricians and Gynecologists, a special-interest group within ACOG, and Gene Rudd, vice president of the Christian Medical and Dental Associations, who resigned from ACOG when he learned of the ethics opinion), is that the ethics policy 1) leaves room for doctors to lose their board certification and 2) could lead to violation of the already iffy Weldon Amendment, which -- did you know about this? -- bars recipients of federal funds from "discriminating" against doctors who refuse to perform or refer for abortions.

Norman F. Gant, M.D., executive director of the American Board of Obstetrics and Gynecology, responded that the issues of abortion and "conscience" are not considerations in the board's certification requirements. ACOG president Kenneth L. Noller, M.D., said the same thing -- but also asked the group's ethics committee to reevaluate the statement.

Feh. It would be one thing, maybe, if the agitation had come only from "inside." But from an HHS with a political agenda? That's hectoring. At best. I'm not convinced a refusal to even refer to -- to use the ACOG's term -- "standard" health services (including contraception! Contraception!) should not result in decertification. If these doctors are that dedicated to "children," I'm sure the American Board of Pediatrics would be delighted to certify them.

Lynn Harris

Award-winning journalist Lynn Harris is author of the comic novel "Death by Chick Lit" and co-creator of BreakupGirl.net. She also writes for the New York Times, Glamour, and many others.

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