Legislatures Grapple with 'Conscience Laws'

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State legislatures and Congress are considering various "conscience laws." They would give health professionals the right to refuse to provide services that violate their moral or religious views. The list of objectionable treatments has expanded far beyond abortion.

LINDA WERTHEIMER, host:

This is WEEKEND EDITION from NPR News.

Coming up, tough times for General Motors.

But, first, the latest debate in health care is about when care does not have to be given. State legislatures and Congress are debating various conscience laws which give health professionals the right to refuse to provide services that violate their moral or religious views. Virtually every state and the federal government already have laws protecting doctors, nurses and other health workers from being obligated to participate in abortions or sterilization procedures. But as NPR's Julie Rovner reports, there's a growing list of treatments to object to, and a growing list of professionals to object.

JULIE ROVNER reporting:

The most visible front in the conscience wars has to do with pharmacists who don't want to dispense emergency contraception, the so-called morning-after pill, or, in some cases, regular birth control pills. Karen Brauer is president of Pharmacists for Life International. She was fired from a Kmart in Ohio for refusing to dispense the birth control pill micronor. She and members of her organization believe that both types of pills can cause abortions by preventing a fertilized egg from implanting in a woman's uterus.

Ms. KAREN BRAUER (President, Pharmacists for Life International): If you are a medical professional, a person who signed up to do a job of healing, and this organization says, `Killing has suddenly become a part of your job, and you have to do it,' that's slavery, and that is usurpation of our human rights and our calling to only help humans, not kill.

ROVNER: The American Pharmacists Association supports the rights of its members to decline to dispense medications that violate their beliefs, says the group's Anne Burns, but at the same time...

Ms. ANNE BURNS (American Pharmacists Association): There need to be procedures or systems in place that make sure that the patient has access to their legally prescribed medication. We like to think of this policy in terms of the pharmacist has the right to step away, but not step in the way of the patient getting their medication.

ROVNER: Burns says the group adopted its policy in 1998. It came in response to an Oregon law allowing doctors to prescribe drugs to terminally ill patients to end their lives. Many pharmacists didn't want to participate in that act, she says, and the policy allowed the state to develop a network of pharmacists who would fill such prescriptions. But Brauer of Pharmacists for Life rejects the idea she should have to refer patients seeking birth control pills or emergency contraception to someone who will provide them.

Ms. BRAUER: Because this is not a medication. This is killing, and it makes no sense to say that a pharmacist should be able to opt not to kill but should help the patient kill anyway.

ROVNER: Florida Democratic Congresswoman Debbie Wasserstein Schultz thinks pharmacists like Brauer are going too far. Wasserstein Schultz is co-sponsoring federal legislation that would require pharmacies, although not individual pharmacists, to fill all legal prescriptions promptly. Wasserstein Schultz, a mother of three, says decisions about birth control are between her and her doctor.

Representative DEBBIE WASSERMAN SCHULTZ (Democrat, Florida): Not between me and my doctor and my pharmacist's conscience. I don't want to get into a moral debate about contraception as I swing through the drive-thru in the pharmacy on my way to pick up my kids from school. And that is exactly what is happening to women across this country.

ROVNER: The pharmacy fight, however, is just the leading edge of a much broader battleground of medical conscientious objectors. Richard Doerflinger is with the National Conference of Catholic Bishops.

Mr. RICHARD DOERFLINGER (National Conference of Catholic Bishops): You have one state, Oregon, that has legalized physician-assisted suicide, and that creates a conscience dilemma for all pharmacists there, and I'm sure that developments on use of fetal tissue, embryonic stem cell research and other morally controversial things are going to raise these issues for a wider range of scientists and physicians in the future.

ROVNER: Such concerns have led to legislation in nearly a dozen states seeking to broaden conscience laws both in terms of who they cover and what they cover; for example, things like complying with living wills or performing in vitro fertilization. Alta Charo, a professor of bioethics at the University of Wisconsin Law School, says she's worried that some of those bills go too far. Legislation pending in Wisconsin, she says, would allow a physician to not inform parents about the existence of chickenpox or rubella vaccines for their children.

Professor ALTA CHARO (University of Wisconsin Law School): Why? Because those vaccines were originally developed using fetal tissue and that, according to the Wisconsin legislation, is a sufficient trigger for a physician to be able to exercise conscience by failing to provide information about the vaccine and, even if the children are harmed as a result, the physician could not be disciplined, could not be sued for malpractice.

ROVNER: Doerflinger of the Catholic Conference says perhaps the answer is for government to pursue less controversial research.

Mr. DOERFLINGER: Should we take into consideration, as the government of all the people, a presumption in favor of funding research toward treatments that every patient will be able to accept and every doctor will be able to use in good conscience? Certainly, if people, for example, making vaccines 30 years ago knew how many pro-life people today would have serious problems of conscience with vaccines that were cultured on fetal tissue from abortions, they might have said, `Gee, we don't want people getting into these dilemmas and maybe ending up denying their children vaccinations because of the association with abortion. Maybe we should make these vaccines another way just out of public health concerns.'

ROVNER: But bioethicist Charo says what's really at issue is not just medical treatment but the meaning of the public square, where people with different beliefs interact.

Prof. CHARO: Is it a place in which all people are equally welcome? Or is it a place in which some people are tolerated but not equally welcome? That is, if I have a belief that it is appropriate to have an abortion, appropriate to use birth control, appropriate to take advantage of embryonic stem cell therapies when they emerge, am I to be given equal access to the medical field or am I simply to be tolerated and given services only when the professionals deem it in their own conscience and interest to provide it?

ROVNER: Charo says hospitals, pharmacies and other institutional health-care providers are losing sight of their obligation to serve all patients.

Prof. CHARO: Patients are at the mercy of the medical profession when they seek medical services, and, therefore, the profession, because it's been given a monopoly, takes on certain heightened obligations to ensure equal and accessible services to all patients. That is, the professional's personal views are not given the same weight as the autonomy interests of the patient.

ROVNER: Meanwhile, says pharmacist Brauer, women who want prescription contraceptives may have to get more persistent.

Ms. BRAUER: Women are gonna have to understand that this is a controversial activity and that they'll have to obtain, you know, in their own way, what they want, that they're not going to be able to ask another person or make another person do it, they're not going to be able to force another person to do it and they're not going to be able to force that person to show them where it is.

ROVNER: That may soon be true in the states considering legislation to allow pharmacists to decline to fill prescriptions on moral or religious grounds. But several other states are considering legislation like the bill introduced in Congress, to require pharmacies to fill prescriptions promptly. Charo says it's not inconceivable that access to medical care could become very different depending on the state you live in. Julie Rovner, NPR News, Washington.

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