Doctors' beliefs can hinder patient care

An ethical dilemma
To many doctors, however, the issue represents a genuine ethical dilemma. "The physician's number-one creed is 'First, do no harm,' " says Sandy Christiansen, M.D., an ob/gyn in Frederick, Maryland, who is active in the Christian Medical and Dental Associations, a 16,000-member group for health care professionals based in Bristol, Tennessee. "I know that life begins at conception, and that each person has inherent value. That includes the life of the unborn." Dr. Christiansen says she will not give abortion referrals, opposes EC and, while she has prescribed birth control, is reconsidering the morality of that position. "Doctors are people, too," she adds. "We have to be able to leave the hospital and live with ourselves. If you feel in your heart an action would cause harm to somebody — born or unborn — it's legitimate to decline to participate."

The American Medical Association in Chicago, the nation's largest physician group, effectively agrees with her; its policy allows a doctor to decline a procedure if it conflicts with her moral ideology. The law also favors medical professionals. In 1973, following Roe v. Wade, Congress passed the so-called Church Amendment, allowing federally funded health care providers to refuse to do abortions. In the years since, 46 states have adopted their own abortion refusal clauses — or, as proponents call them, conscience clauses — allowing doctors to opt out. Now many states have gone further. Sixteen legislatures have given doctors the right to refuse to perform sterilizations; eight states say doctors don't have to prescribe contraception. "This is about the rights of the individual, about our constitutional right to freedom of religion," says Frank Manion, an attorney with the American Center for Law and Justice, a legal group in Washington, D.C. Founded by minister Pat Robertson, the organization has represented health care providers and lobbied for laws that protect them. "We're not trying to deny anybody access to treatment," Manion adds. "We're saying, 'Don't make your choice my choice.' "

When Elizabeth Dotts walked into her new doctor's office for a gynecologic exam and checkup, she didn't realize she was treading into the front lines of a culture war. "I was just going for my annual visit, nothing out of the ordinary," says the 26-year-old YWCA grant coordinator. Dotts, who was single, had recently moved to Birmingham, Alabama, and was seeing an M.D. recommended by a coworker. The visit was unremarkable until she asked for a refill of her birth control prescription. That's when the doctor informed her that he was Catholic and the pills were against his religion.

"The look he gave me actually made me feel ashamed," Dotts says. "Like I had this wild and crazy sex life. Like he was trying to protect me from myself." Her bewilderment quickly turned to anger — "I thought, 'Wait, what in the world? Where am I?' " — especially when she remembered that her insurance covered only one annual gynecology checkup. Dotts, who'd majored in religion in college, got tough with the doctor.

"I'm glad for you that you're faithful," she told him. "But don't push it on me. I'm here for my treatment, and I expect you to give it to me." Five minutes of verbal sparring later, the doctor relented with a six-month prescription — but only after Dotts told him she had been put on the Pill to relieve menstrual cramping, not to prevent pregnancy. Dotts grabbed the prescription and left, resolving to find herself a new gynecologist. "Before, walking into a doctor's office, I assumed we were on the same side," she says. "I don't make that assumption now. I ask a million questions and advocate for myself."

Bills to protect patients
This tug-of-war between physicians and patients is playing out in state legislatures, where a handful of bills aim to protect women. A Pennsylvania proposal, for example, would compel ER doctors to provide rape victims with information about emergency contraception and to dispense it on request — a law already on the books in California, Massachusetts, New Jersey, New Mexico, New York, Ohio and Washington. A federal version of the bill is under consideration by a House subcommittee.

But such efforts have been more than matched by those of conscience-clause activists. Since 2005, 27 states introduced bills to widen refusal clauses. Four states are considering granting carte blanche refusal rights — much like the law adopted by Mississippi in 2004, which allows any health care provider to refuse practically anything on moral grounds. "It's written so broadly, there's virtually no protection for patients," says Adam Sonfield, senior public policy associate for the Washington, D.C., office of the Guttmacher Institute, a reproductive-health research group. Sonfield notes that many refusal clauses do not require providers to warn women about restrictions on services or to refer them elsewhere. "You have to balance doctors' rights with their responsibilities to patients, employers and communities," he adds. "Doctors shouldn't be forced to provide services, but they can't just abandon patients."

In theory, the laws aren't aimed solely at women's health — a bill in New Jersey lists eye doctors and prosthetics technicians as examples of providers who'd be allowed to refuse care based on their beliefs. But Morrison warns women not to be fooled. "I ask you, what belief would keep someone from fitting a patient with a prosthetic limb?" she asks. "What they're really after is limiting access to women's health care. Reproductive health is seen as something other than regular health care" — not a straightforward matter of treating and healing, but something laden with morality — "and if you treat it that way, it becomes something providers can say yes or no to." Men, for the most part, escape such scrutiny: It's pretty hard to imagine someone being made to feel he's going straight to hell for choosing to take Viagra or get a vasectomy. And if women come to fear their doctors' judgments, a new set of problems can develop. "Then you have women who don't communicate with their doctors or avoid getting care," Morrison warns. "Any way you look at it, it's dangerous for women."

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