Health workers may get the right to refuse to act

WASHINGTON — More than a dozen states are considering new laws to protect health workers who do not want to provide care that conflicts with their personal beliefs, a surge of legislation that reflects the intensifying tension between asserting individual religious values and defending patients' rights.

About half of the proposals would shield pharmacists who refuse to fill prescriptions for birth control and "morning-after" pills because they believe the drugs cause abortions.

But many are far broader measures that would shelter any doctor, nurse, aide, technician or other employee who objects to any therapy. That might include in-vitro fertilization, physician-assisted suicide, embryonic stem cells, and perhaps even providing treatment to gays and lesbians.

The flurry of political activity is being welcomed by conservative groups that consider it crucial to prevent health workers from being coerced into participating in care they find morally repugnant — protecting their "right of conscience" or "right of refusal."

"This goes to the core of what it means to be an American," said David Stevens, executive director of the Christian Medical & Dental Associations. "... Doctors, dentists, nurses and other health-care workers should not be forced to violate their consciences."

The swell of propositions is raising alarm among advocates for abortion rights, family planning, AIDS prevention, gays and lesbians, and the right to die, and others who see the push as the latest manifestation of the growing political power of social conservatives.

"This a very significant threat to patients' rights in the United States," said Lois Uttley of the MergerWatch project, who is helping to organize a conference in New York to plot a counter strategy. "We need to protect the patients' right to use their own religious or ethical values to make medical decisions."

Both sides agree the struggle between personal beliefs and professional medical responsibilities is likely to escalate as more states consider approving physician-assisted suicide, as embryonic stem cell research speeds forward and other advances open more ethical fault lines.

"We are moving into a brave new world of cloning, cyborgs, sex selection, genetic testing of embryos," Stevens said. "The list of difficult ethical issues ... is just continuing to increase."

Most states have long had laws to protect doctors and nurses from being fired, disciplined or sued, or facing other legal action if they do not want to perform abortions.

Conflicts over other health-care workers emerged after the "morning-after" pill was approved and pharmacists began refusing to fill prescriptions for it, with the result that some lost their jobs, were reprimanded or were sanctioned by state licensing boards.

That prompted a number of states last year to consider new laws that would either explicitly protect pharmacists or require them to fill such prescriptions.

At least seven states are considering laws that would specifically protect pharmacists or pharmacies.

"Every other day I hear from pharmacists who are being threatened or told they have to sign something that says they are willing to go along with government mandates," said Francis Manion of the American Center for Law & Justice, which is fighting an Illinois regulation implemented last year requiring pharmacies to fill all prescriptions, which led to a number of pharmacists being fired.

Opponents argue that such laws endanger patients by denying them access to legal drugs, particularly "morning-after" pills, which must be taken soon after unprotected sex.

"Women all over the country are being turned away from obtaining valid and legal prescriptions," said Jackie Payne of the Planned Parenthood Federation of America. "These kinds of laws would only make the situation worse. It's shameful."

Planned Parenthood is supporting efforts in at least six states to pass laws requiring pharmacists to fill all prescriptions.

At least nine states are considering "right of refusal" bills that are far broader. Some would protect virtually any worker involved in health care, while others would also extend protection to hospitals, clinics and other facilities.

At least five bills would allow insurance companies to opt out of covering services they say they find objectionable for religious reasons.

"These represent a major expansion of this notion of right of refusal," said Elizabeth Nash of the Guttmacher Institute, a nonprofit organization that studies reproductive health issues and is tracking the legislation. "You're seeing it broadening to many types of workers — even into the world of social workers — and for any service for which you have a moral or religious belief."