Missouri bill would let health providers opt out of more reproductive services

The Kansas City StarMarch 11, 2013 

— Laws allowing health care workers to refuse to participate in an abortion have been on the books for decades.

Missouri legislators, however, don’t think they go far enough.

They want to expand those laws to allow medical professionals to opt out of providing birth control, sterilization and assisted reproduction services and stem cell research. They would also be able to deny referrals for care.

Under legislation that could come up for a vote in the Missouri House as early as today, health care providers would be shielded from punishment for refusing to provide this type of care if it violates their religious or moral principles.

“This bill provides workers with a shield to allow them to exercise their religious beliefs, which are sacrosanct in both our state and federal constitution,” said House Speaker Tim Jones, a Eureka Republican sponsoring the measure.

The proposal alarms critics, who denounce it as a potentially deadly change to health care policy. The bill is too broad, they complain, and sacrifices the health of women to the religious beliefs of medical providers.

“Medicine is not supposed to be about the values of the physician or the institution,” said Ed Weisbart, a family physician from St. Louis. “It’s supposed to be about the values of the patient. Period.”

Shortly after the U.S. Supreme Court’s 1973 decision legalizing abortion, state governments around the country began enacting laws to allow health care workers and the institutions they work for to refuse to provide abortions without facing legal, financial or professional consequences.

According to the reproductive health research organization the Guttmacher Institute, 46 states — including Missouri and Kansas — allow health care providers to refuse to provide abortion services. Thirteen states take it a step further and allow refusal of services related to contraception, and 18 extend it to sterilization services.

Last year, Kansas Gov. Sam Brownback signed into law a bill allowing pharmacists to refuse to provide drugs they believe might cause an abortion.

The Missouri legislation would prevent a health care worker or institution that refuses to participate in procedures from being punished.

The right to refuse care would not apply to medical emergencies, Jones said. Employees would have to provide reasonable notice to their employers of their moral objections before refusing to participate in procedures or counseling they find offensive.

“An employee cannot use the surprise tactic and suddenly wake up one day and proclaim a moral objection,” Jones said.

But Daniel Landon, a lobbyist for the Missouri Hospital Association, questioned what “reasonable notice” in such situations might be.

“It is unclear how a hospital human resources department would know whether that applies to one of their employees without diving into their private religious life in ways that many of us would be uncomfortable with,” Landon said.

Health care institutions have a duty to ensure that patients receive accurate information and appropriate care, said Michelle Trupiano, public affairs manager for Planned Parenthood of Kansas and Mid-Missouri.

Failure to provide that care jeopardizes patient health, she said, even in situations that may not initially be considered life-threatening.

“A woman with an ectopic pregnancy that isn’t considered life-threatening could be denied care, including a referral as to where to receive care, until she comes back so sick that her life is in danger,” Trupiano said.

Rape survivors could be refused information and access to emergency contraception, Trupiano said, which would deny them “the minimum standard of care determined by leading health care organizations such as the American Medical Association.”

“That is unconscionable.”

Weisbart, the St. Louis doctor, said it would also violate “the core ethical basis of medicine.”

“This bill would protect my right to not tell (a patient) about emergency contraception,” he said. “When did that become my right? What happened to her right to know about her legal and medically appropriate options? When did the moral values of the physician become more important than those of our patients?”

Anyone choosing to be a doctor is promising to “provide the best medicine available,” Weisbart said.

Supporters of the bill counter that health care providers should not be forced to choose between their personal convictions and their professional career. Joe Ortwerth, executive director of Missouri Family Policy Council, said most people go into the medical profession out of a desire to “foster human life.”

“They take seriously the credo to do no harm,” Ortwerth said. “Unfortunately, there are certain circumstances where they are asked to potentially do harm to human life and go against the values and beliefs they hold.”

Rep. David Wood, a Versailles Republican, said if a doctor or facility is unable to provide the requested care, “there’s nothing stopping a patient, if it’s not an emergency, from going to another hospital.”

That’s only true, Trupiano said, if the patient doesn’t live in a rural area where there are no other options and has adequate transportation.

Despite the opposition, most expect the bill will make its way quickly through the House and over to the Senate, where a similar bill has been filed by Sen. Scott Rupp, a Wentzville Republican.

The legislation is “near and dear to me,” Jones said, which is why it is one of only three bills he has agreed to sponsor so far this year.

“When people are faced with situations that fly in the face of their religious convictions,” Jones said, “I think they should be protected.”

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