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Posted: April 29th, 2018
Conscience Clause Legislation and Access to Reproductive Healthcare Services
Conscience clause legislation refers to laws or policies that allow health care workers or institutions to refuse to provide certain reproductive health services, such as abortion, sterilization, contraception, or assisted suicide, on the grounds of religious or moral beliefs. These laws or policies are often justified as a way of protecting the freedom of conscience and religion of health care providers. However, they can also have negative consequences for patients’ access to reproductive health care, especially for women and girls, who may face barriers, delays, discrimination, or denial of services.
According to the Center for Reproductive Rights, 46 states in the US already have laws or policies allowing health care entities to refuse to provide abortion services. Moreover, in May 2019, the US Department of Health and Human Services (HHS) issued a final rule that heightened the rights of hospitals and health workers to refuse to participate in patients’ medical care based on religious or moral grounds. The rule covered 25 federal “conscience protection” laws and applied to a range of important health services such as abortions, sterilizations, assisted suicide, and advance directives. The rule also extended to sex reassignment and HIV treatment.
The HHS rule was challenged in court by several states, municipalities, and civil society organizations, who argued that it violated the Constitution and federal laws, and that it threatened the health and rights of millions of Americans. In November 2019, a federal judge in New York blocked the rule from taking effect, finding that it was “arbitrary and capricious” and that it conflicted with existing laws that require health care providers to offer emergency care and referrals. The judge also noted that the rule would cause “enormous and irreversible” harm to patients who rely on federally funded health programs.
In July 2022, President Biden issued an executive order that revoked the HHS rule and directed federal agencies to ensure that patients have access to reproductive health care services without discrimination or interference. The executive order also reaffirmed the government’s commitment to uphold international human rights standards on sexual and reproductive health and rights, and to support global efforts to eliminate barriers to reproductive health care.
The debate over conscience clause legislation reflects a tension between competing rights and interests: the right of health care providers to act according to their conscience and religion, and the right of patients to access quality and timely reproductive health care services. While international human rights bodies have not explicitly determined whether states have a positive obligation to recognize conscientious objection in the provision of health care, they have consistently raised concern about the impact of such refusals on access to abortion services. They have also outlined minimum safeguards that states must implement if they permit conscientious objection, such as ensuring an adequate number and distribution of willing providers, prohibiting institutional refusals of care, establishing an effective referral system, imposing clear limits on the legality of refusals, and implementing adequate monitoring, oversight, and enforcement mechanisms.
References:
– Gostin LO. The “Conscience” Rule: How Will It Affect Patients’ Access to Health Services? JAMA. 2019;321(22):2152-2153. doi:10.1001/jama.2019.7656
– Center for Reproductive Rights. Law and Policy Guide: Conscientious Objection. https://reproductiverights.org/maps/worlds-abortion-laws/law-and-policy-guide-conscientious-objection/. Accessed February 19, 2024.
– Executive Order on Protecting Access to Reproductive Healthcare Services. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/07/08/executive-order-on-protecting-access-to-reproductive-healthcare-services/. Accessed February 19, 2024.
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