"Conscience" clauses allow US corporate providers to refuse care
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《英国医生杂志》
"Refusal clauses" and "conscience exceptions," which allow US doctors, nurses, and healthcare workers to refuse to provide certain types of health care to patients, are being extended to hospitals, insurance companies, pharmacies, and managed care companies.
New legislation may upset the balance between providers who refuse to provide care to which they have ethical objections and patients?ability to get the care they want and need.
Most of the new laws are at the state level, but federal legislation may be reintroduced before Congress adjourns for the November elections. The laws allow hospitals, insurance and managed care companies, and pharmacies to deny care for services to which they object, such as abortion, contraception, sterilisation, in vitro fertilisation, and medical research involving embryonic stem cells.
The laws protect them from liability if they do not inform a patient about such treatment, do not offer the treatment, or do not refer to a provider who does offer it. And although the current focus is on reproductive health services, the laws are so broadly written that they may apply to end of life and other health issues.
Mergers of pharmacy chains, hospital chains, and insurance companies mean that rules from a restrictive, religiously affiliated organisation may be applied when it merges with a secular institution.
Susanne Martinez, vice president for policy at Planned Parenthood, said the organisation was "very worried" about the "sweeping" effect of legislation to restrict women抯 ability to exercise their reproductive rights.
The organisation was also concerned about the short time for legislative decisions, because the proposed Abortion Non-Discrimination Act may be acted on this autumn. The bill, drafted by the US Conference of Catholic Bishops, says that providers who refuse to provide services such as abortion cannot be discriminated against. Providers who receive federal funds for family planning are now required to provide information about, pay for, and refer for abortions.
The clauses and exceptions go back to the Supreme Court抯 1973 Roe v Wade decision, which permitted abortion. Medical workers were allowed to opt out of providing services to which they had objections.
The problem was highlighted in an article by Adam Sonfield, a policy associate at the non-profit Alan Guttmacher Institute (www.guttmacher.org/journals/gr070301.html) that described the recently passed comprehensive state law in Mississippi. It says that individuals, institutional providers of care, and those who pay for health care can refuse to be involved in any service to which they object on moral, ethical, or religious grounds, free from liability, and regardless of the effects on patients and employers. The law covers counselling, diagnosis and research, and administering a drug, device, surgery, care, or treatment. It protects people who work for a hospital, clinic, nursing home, pharmacy, or medical school and students, counsellors, and "any other person who furnishes, or assists in the furnishing of, a health care procedure."
The conflict between federal rules about family planning funds, which say information about abortion should be given to clients who ask, and state "conscience" clauses, has not yet been addressed.
So far, the "conscience" problem has occurred mostly at the state level. Pharmacists have refused to fill prescriptions for contraceptives and refused to refer patients to other pharmacists or to transfer their records. The American Pharmacists Association said that members have the right to refuse but must assure that patients have access to care.
However, when Dr Amy Breakstone, a gynaecologist in Bristol, Connecticut, called her local Wal-Mart pharmacy, part of the largest company in the world, to prescribe emergency contraception for a patient, she was told the pharmacy did not stock the two drugs she prescribed and would not provide the oral contraceptive she had prescribed as an alternative for the same purpose. The east coast state of Connecticut, between New York and Boston, is home to Yale and other universities and is usually considered a liberal area.(New York Janice Hopkins T)
New legislation may upset the balance between providers who refuse to provide care to which they have ethical objections and patients?ability to get the care they want and need.
Most of the new laws are at the state level, but federal legislation may be reintroduced before Congress adjourns for the November elections. The laws allow hospitals, insurance and managed care companies, and pharmacies to deny care for services to which they object, such as abortion, contraception, sterilisation, in vitro fertilisation, and medical research involving embryonic stem cells.
The laws protect them from liability if they do not inform a patient about such treatment, do not offer the treatment, or do not refer to a provider who does offer it. And although the current focus is on reproductive health services, the laws are so broadly written that they may apply to end of life and other health issues.
Mergers of pharmacy chains, hospital chains, and insurance companies mean that rules from a restrictive, religiously affiliated organisation may be applied when it merges with a secular institution.
Susanne Martinez, vice president for policy at Planned Parenthood, said the organisation was "very worried" about the "sweeping" effect of legislation to restrict women抯 ability to exercise their reproductive rights.
The organisation was also concerned about the short time for legislative decisions, because the proposed Abortion Non-Discrimination Act may be acted on this autumn. The bill, drafted by the US Conference of Catholic Bishops, says that providers who refuse to provide services such as abortion cannot be discriminated against. Providers who receive federal funds for family planning are now required to provide information about, pay for, and refer for abortions.
The clauses and exceptions go back to the Supreme Court抯 1973 Roe v Wade decision, which permitted abortion. Medical workers were allowed to opt out of providing services to which they had objections.
The problem was highlighted in an article by Adam Sonfield, a policy associate at the non-profit Alan Guttmacher Institute (www.guttmacher.org/journals/gr070301.html) that described the recently passed comprehensive state law in Mississippi. It says that individuals, institutional providers of care, and those who pay for health care can refuse to be involved in any service to which they object on moral, ethical, or religious grounds, free from liability, and regardless of the effects on patients and employers. The law covers counselling, diagnosis and research, and administering a drug, device, surgery, care, or treatment. It protects people who work for a hospital, clinic, nursing home, pharmacy, or medical school and students, counsellors, and "any other person who furnishes, or assists in the furnishing of, a health care procedure."
The conflict between federal rules about family planning funds, which say information about abortion should be given to clients who ask, and state "conscience" clauses, has not yet been addressed.
So far, the "conscience" problem has occurred mostly at the state level. Pharmacists have refused to fill prescriptions for contraceptives and refused to refer patients to other pharmacists or to transfer their records. The American Pharmacists Association said that members have the right to refuse but must assure that patients have access to care.
However, when Dr Amy Breakstone, a gynaecologist in Bristol, Connecticut, called her local Wal-Mart pharmacy, part of the largest company in the world, to prescribe emergency contraception for a patient, she was told the pharmacy did not stock the two drugs she prescribed and would not provide the oral contraceptive she had prescribed as an alternative for the same purpose. The east coast state of Connecticut, between New York and Boston, is home to Yale and other universities and is usually considered a liberal area.(New York Janice Hopkins T)