Health Care Providers' Conscience Clauses - How Far Do They Go?

[WhyNot]

I’ve been without regular internet access, so I’m too far behind on the Pharmacists and refusals thread to catch up now, but I have a related GQ:

How are these “conscience clauses” limited? Are they limited to religiously based conscience alone? Or can a healthcare provider (pharmacist, nurse, respiratory therapist, etc.) refuse to carry out an MD’s order because they don’t think the medical evidence indicates it’s the best option for the patient? (I know nurses can/should refuse to carry out an *unsafe *order, but that’s different.) What if they just personally dislike it, or find it immoral, but not proscribed by their religion?

Is it just abortion and birth control? Or can a nurse refuse to treat a gay patient because she thinks gay people are evil and going to hell? (Our test questions say no, she can’t, but they were written before these clauses came to be.) Or can a resp. therapist refuse to give breathing treatments to an alcoholic because he was physically abused by an alcoholic father and thinks alcoholics deserve to die?

Is it just Christian religious doctrines that are protected? What if a pharmacist is an Orthodox Jew, or devout Muslim? Can they refuse to dispense porcine (pig) based or derived drugs like Heparin?

[Captain_Amazing]

It obviously depends on the state. Here’s a partial list, along with the codes for reference, from the NCSL:

http://www.ncsl.org/default.aspx?tabid=14380

Here’s Arkansas, picked because it’s the first on the list:

It shall be the policy and authority of this state that:

(1) All medically acceptable contraceptive procedures, supplies, and information shall be available through legally recognized channels to each person desirous of the procedures, supplies, and information regardless of sex, race, age, income, number of children, marital status, citizenship, or motive;

(2) Medical procedures for permanent sterilization, when performed by a physician on a requesting and consenting person eighteen (18) years of age or older, or less than eighteen (18) years of age if legally married, be consistent with public policy;

(3) Dissemination of medically acceptable contraceptive information in this state and in state and county health and welfare departments, in medical facilities, at institutions of higher learning, and at other agencies and instrumentalities of this state be consistent with public policy;

(4) Nothing in this subchapter shall prohibit a physician, pharmacist, or any other authorized paramedical personnel from refusing to furnish any contraceptive procedures, supplies, or information; and

(5) No private institution or physician, nor any agent or employee of the institution or physician, nor any employee of a public institution acting under directions of a physician, shall be prohibited from refusing to provide contraceptive procedures, supplies, and information when the refusal is based upon religious or conscientious objection. No such institution, employee, agent, or physician shall be held liable for the refusal.

and California:

(a) No licentiate shall obstruct a patient in obtaining a prescription drug or device that has been legally prescribed or ordered for that patient. A violation of this section constitutes unprofessional conduct by the licentiate and shall subject the licentiate to disciplinary or administrative action by his or her licensing agency

(b) Notwithstanding any other provision of law, a licentiate shall dispense drugs and devices, as described in subdivision (a) of Section 4024, pursuant to a lawful order or prescription unless one of the following circumstances exists:. . .

(3) The licentiate refuses on ethical, moral, or religious grounds to dispense a drug or device pursuant to an order or prescription. A licentiate may decline to dispense a prescription drug or device on this basis only if the licentiate has previously notified his or her employer, in writing, of the drug or class of drugs to which he or she objects, and the licentiate’s employer can, without creating undue hardship, provide a reasonable accommodation of the licentiate’s objection. The licentiate’s employer shall establish protocols that ensure that the patient has timely access to the prescribed drug or device despite the licentiate’s refusal to dispense the prescription or order. For purposes of this section, “reasonable accommodation” and “undue hardship” shall have the same meaning as applied to those terms pursuant to subdivision (l) of Section 12940 of the Government Code.

So, if you look at just those two laws, in one way, California restricts pharmacists more, because it requires that some sort of reasonable accommodation be made for the patients first. In another, Arkansas does, because in Arkansas, the pharmacist can only refuse contraceptives, while in California, he can refuse any class of drugs he has an objection to.

As to your last question, I can’t see any state would reject the conscience clause only to Christians. That would certainly be unconstitutional under the 1st Amendment.

[Nava]

Varies by location yadda yadda.

For any item on which it is possible to declare oneself an “objector by reason of conscience”, Spanish law doesn’t take religion into account. It is not limited to Christians, it is not limited to religions recognized by the Spanish government for other purposes, it is not limited to people who have any kind of religion. You can believe in the spaghetti monster or be an atheist, and it won’t even come up in the process.

There are cases where objection is possible only for a short time (performing same-sex marriages: those town councilors which were in office when that law was approved could refuse to perform SSM while still performing OSM; now if you’re elected and you indicate you’re willing to perform marriages, which not every councilor does, you have to perform both kinds of marriages) and others where the possibility is permanent (military objectors between the time the legal figure was created and the end of the draft; performing abortions). Any law which indicates it is possible to declare oneself an objector will specify the limits, both in scope and time.