Medical conscience clause in Ohio budget bill serves no purpose, health experts say – cleveland.com
CLEVELAND, Ohio — A new Ohio law that would let doctors and nurses refuse to treat people on the basis of “moral, ethical or religious beliefs” is unnecessary, public health experts say.
The so-called “medical practitioner conscience clause” is part of the recently passed budget bill.
It “recognizes the authority of a medical practitioner, health care institution, or health care payer to decline to perform, participate in, or pay for any health care service that violates the practitioner’s, institution’s, or payer’s conscience as informed by the moral, ethical, or religious beliefs or principles held by the practitioner, institution, or payer.” Health care payer refers to a health insurance company.
But the American Medical Association, and many hospital systems, already give caregivers the right, in non-emergency situations, to decline to provide care to a patient under certain limited circumstances.
This can happen when the patient requests care that “is incompatible with the physician’s deeply held personal, religious, or moral beliefs in keeping with ethics guidance on exercise of conscience,” the AMA’s code of ethics says.
“The conscience protections for healthcare professionals are long standing under current law, and hospitals have policies in place to accommodate differing religious and moral conventions of their workforce,” said Kelly O’Reilly, president and CEO of the Ohio Association of Health Plans. “It didn’t need to be codified in Ohio statute. It really was a solution in search of a problem.”
Ohio’s conscience protection clause “recognizes the authority of a medical practitioner, health care institution, or health care payer to decline to perform, participate in, or pay for any health care service that violates the practitioner’s, institution’s, or payer’s conscience as informed by the moral, ethical, or religious beliefs or principles held by the practitioner, institution, or payer.” Health care payer refers to a health insurance company.
House Bill 110, which took effect in July, requires a medical practitioner to notify his or her supervisor, request to be excused from the service and “if willing,” seek another provider to deliver care.
If care is not transferred or a colleague is unwilling to perform the service, the patient must be notified and given an opportunity to find an alternative medical provider.
The new law was opposed by Ohio’s major associations representing hospitals, doctors and health insurance providers, including the Ohio Association of Health Plans.
LGBTQ rights groups also objected. Gov. Mike DeWine responded by saying that LGBTQ Ohioans can find other medical providers if the first ones they approach refuse to treat them.
Ohio joined other states that have given doctors the right not to treat certain patients, especially those who are LGBTQ, for moral reasons. These laws have been passed or considered in Arkansas, Tennessee and Florida.
But a state-wide medical practitioner conscience clause wasn’t needed here, said Dr. Mike Sevilla, president of the Ohio Academy of Family Physicians.
“The best thing would be to eliminate it, because I think it causes more confusion than the solutions that they were trying to do,” Sevilla said.
‘Free to choose whom to serve’
Federal laws regarding the right of medical providers to choose which patients to treat sometimes contradict state and local laws.
For instance, federal policy prohibits hospitals from denying treatment to anyone who is facing a life-threatening emergency, or on the basis of a person’s age, faith, race or sexual orientation.
Yet many states allow physicians to refuse treatment in non-emergencies to patients whose behavior is threatening or dangerous, or on moral grounds, according to press reports.
Some faith-based hospitals use their code of ethics to justify refusing a treatment that challenges their religious beliefs, even in emergencies.
Many hospitals added a conscience clause to their list of ethics during the 1970s, when patients began to ask to have life sustaining treatment withdrawn, said Mark Aulisio, professor and chair of the bioethics department at Case Western Reserve University. Medical centers allowed healthcare professionals who were uncomfortable performing certain procedures to step aside and allow other physicians and nurses to deliver care, he said.
Lawsuits involving caregivers who decline care for ethical reasons usually center on hot-button issues such as abortion or prescriptions for the morning-after pill, Aulisio said.
“All across the country, from the early 2000s forward, there have been scores of pieces of legislation proposed that protect — or purport to protect — the rights of conscience for healthcare professionals,” Ausilio said. “They appear to be largely legislative efforts to solve a problem that doesn’t really exist. We don’t have a whole bunch of cases of people being forced to do something that they say is against their conscience.”
Ohio’s medical associations are lobbying in Columbus to introduce new legislation to correct the clause, and urge their members to let their state representatives know their objections to it, Sevilla of the Ohio Academy of Family Physicians said.
Even if the conscience clause isn’t eliminated, it might simply gather dust and rarely be implemented, observers said.
Public attitudes have become more tolerant towards LGBTQ people, making it less likely that a medical practitioner would refuse to treat a gay patient or decline to provide a medical service related to gender transition, Aulisio said.
“I think it’s a really poor piece of legislation,” he said about the Ohio law. “It’s overly broad and poorly written, but I doubt that in the end it’s going to actually make all that much difference in practice.”