From “Right to Refuse” to “Right to Obstruct:” Kansas and Nebraska Seek to Dramatically Expand Power Over Patients

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From “Right to Refuse” to “Right to Obstruct:” Kansas and Nebraska Seek to Dramatically Expand Power Over Patients

Kari Ann Rinker

Among the literally life-threatening laws being considered in various states are expanded refusal clauses that not only allow various health care workers, including pharmacists, refuse to provide health care or a prescription, but also to refuse to refer to another provider or pharmacist for anything they find “objectionable.”

Since President Obama stood up to the bullying of the Catholic Bishops and found a way to make sure birth control remains accessible for all women, regardless of their employer, conscience clauses are becoming “all the rage.”

Many states already have conscience refusal laws for abortion already on the books.  Nebraska is one of these states. A bill was introduced last year to expand the refusal clause in Nebraska to “embryonic stem cells, fetal tissue and end of life care.”  This bill is now being amended a’ la Blunt, in that it would allow conscience refusals across the full gamut of health care. 

The World-Herald Bureau wrote about some possible applications of such a law…

Others are questioning the measure’s breadth and whether it appropriately balances providers’ conscience rights with the rights of employers and patients.

Sex. Abortion. Parenthood. Power.

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Would it have protected, for example, the Pennsylvania admissions clerk who refused to type up lab and admissions forms for abortion patients?

Would it protect a dietitian who objects to killing animals for food and refuses to participate in anything involving meat?

Would it protect a nurse who refuses to care for an AIDS patient because of objections about the patient’s homosexuality?

The Nebraska amendment also includes a “referral clause,” which would allow health care workers and pharmacists not only to refuse to provide care they may find “objectionable,” but also allow to refuse to refer patients to other doctors, clinics, or pharmacies. 

Kansas is also considering an expansion to the existing abortion refusal law, expanding a so-called conscience clause from refusal to provide abortion specfically to “an effect the person reasonably believes may result in the termination of a pregnancy.”  Some people might “reasonably believe” that a baby aspirin might cause an abortion, or a certain cold medicine, and at this point it is clear there are people who “reasonably believe” that fertilized eggs are people.  At the Kansas hearing for the conscience refusal bill, committee participants were told stories of physicians “forced” to insert IUD’s into women and the personal moral pain it placed upon them at the prospect of killing “baby zygotes.” 

One of the most troubling aspects of these bills is the lack of referral.  Something to consider from Kansas NOW’s testimony in opposition to HB 2523:

The American Public Health Association deems refusal clauses as being appropriate only if they provide an adequate plan for referral and do not disrupt or obstruct a patient’s access to care. 

  • HB 2523 does not allow for an adequate plan for referral. Instead, it intentionally includes language that would allow for the absolute denial of a referral, leaving women in need of health care without any medical advice or direction. 

This is especially a concern of women living in rural areas of Nebraska and Kansas.   Many rural counties lack a pharmacy or have only one pharmacy. 

Representative Annie Tietze offered an amendment to the Kansas bill to strike the referral clause.  She stated, “the bill only seemed to have the interests of the health care professional in mind, leaving no regard for the patient.”  This common sense amendment was voted down.

Health care should exist to serve the needs of the patient…first and foremost.  As Margaret McLean puts it,  “the right to refuse should not include the right to obstruct.”