Refusing to provide health services.
BACKGROUND: Almost every state has a policy explicitly allowing some health care professionals or certain institutions to refuse to provide or participate in abortion, contraceptive contraceptive /con·tra·cep·tive/ (-sep´tiv)
1. diminishing the likelihood of or preventing conception.
2. an agent that so acts. services or sterilization sterilization
Any surgical procedure intended to end fertility permanently (see contraception). Such operations remove or interrupt the anatomical pathways through which the cells involved in fertilization travel (see reproductive system). services. Even in states without explicit refusal statutes, an individual health care professional's actions may be legally protected by statutes prohibiting discrimination against employees, based on their religious objections. While some of the institutional policies are limited to private, or even religious, health care institutions, others apply to all institutions providing health care. (At the federal level, health care institutions and providers may refuse to participate in abortion services on the basis of their religious or moral beliefs.)
A few states have enacted laws that specifically allow pharmacists This is a list of notable pharmacists.
Pharmacies in Australia are mostly independently-owned by pharmacists, often operated as franchises of retail brands offered by the three major to refuse to provide health care due to religious or moral objections. Several other states have broadly worded refusal clause statutes that might protect pharmacists or pharmacies from liability for their refusal. (See Emergency Contraception Emergency Contraception Definition
Emergency contraception or emergency birth control uses either emergency contraceptive pills (ECPs) or a Copper-T intrauterine device (IUD) to help prevent pregnancy following unprotected vaginal intercourse. .)
* 46 states allow some health care providers to refuse to provide abortion services.
* All of these states permit individual health care providers to refuse to provide abortion services.
* 43 states allow health care institutions to refuse to provide abortion services, 14 limit the exemption to private health care institutions and 1 state allows only religious health care entities to refuse to provide such care.
* 13 states allow some health care providers to refuse to provide services related to contraception contraception: see birth control.
Birth control by prevention of conception or impregnation. The most common method is sterilization. The most effective temporary methods are nearly 99% effective if used consistently and correctly. .
* 8 states allow individual health care providers to refuse to provide services related to contraception
* 4 states explicitly permit pharmacists to refuse to dispense dispense /dis·pense/ (-pens´) to prepare medicines for and distribute them to their users.
To prepare and give out medicines. contraceptives. (5 additional states have broad refusal clauses that do not specifically include pharmacists, but may apply to them.)
* 1 state explicitly permits pharmacies to refuse to dispense contraceptives.
* 4 states have broad refusal clauses that do not specifically include pharmacies, but may apply to them.
* 9 states allow health care institutions to refuse to provide services related to contraception, 6 states limit the exemption to private entities.
* 17 states allow some health care providers to refuse to provide sterilization services.
* 16 states allow individual health care providers to refuse to provide sterilization services.
* 15 states allow health care institutions to refuse to provide sterilization services; 4 limit the exemption to private entities.
FOR MORE INFORMATION:
For information on state legislative and policy activity click on Guttmacher's Monthly State Update and for state level information and data on reproductive health Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene issues, click on Guttmacher's State Center.
Sonfield A, Proposed 'conscience' regulation opposed widely as threat to reproductive health and beyond, Guttmacher Policy Review, 2008, 11(4):17-19.
Sonfield A, Provider refusal and access to reproductive health services: approaching a new balance, Guttmacher Policy Review, 2008, 11(2):2-6.
Guttmacher Institute The Guttmacher Institute (formerly The Alan Guttmacher Institute) advances sexual and reproductive health in the United States and globally through an interrelated program of social science research, public education, and policy analysis. , Striking a balance between a provider's right to refuse and a patient's right to receive care, 2005.
Dailard C, Beyond the issue of pharmacist pharmacist /phar·ma·cist/ (fahr´mah-sist) one who is licensed to prepare and sell or dispense drugs and compounds, and to make up prescriptions.
n. refusals: pharmacies that won't sell emergency contraceptives, The Guttmacher Report on Public Policy, 2005, 8(3):10-12.
Sonfield A, Rights vs. responsibilities: professional standards and provider refusals, The Guttmacher Report on Public Policy, 2005, 8(3):7-9.
Sonfield A, New refusal clauses shatter shat·ter
v. shat·tered, shat·ter·ing, shat·ters
1. To cause to break or burst suddenly into pieces, as with a violent blow.
a. balance between provider 'conscience,' patient needs, The Guttmacher Report on Public Policy, 2004, 7(3):1-3.
Gold RB, Future uncertain for Catholic plans' creative approaches to providing contraceptive access, The Guttmacher Report on Public Policy, 2000, 3(6):1-2 & 14.
Gold RB and Sonfield A, Refusing to participate in health care: a continuing debate, The Guttmacher Report on Public Policy, 2000, 3(1):8-11.
Dailard C, State contraceptive coverage laws: creative responses to questions of 'conscience', The Guttmacher Report on Public Policy, 1999, 2(4):1-2 & 14.
(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. SA, Objections, confusion among pharmacists threaten access to emergency contraception, The Guttmacher Report on Public Policy, 1999, 2(3):1-3.
Gold RB, Contraceptive coverage: toward ensuring access while respecting conscience, The Guttmacher Report on Public Policy, 1998, 1(6):1-2 & 14.
Donovan Don·o·van , William Joseph Known as "Wild Bill." 1883-1959.
American army officer and public official who founded and directed (1942-1945) the Office of Strategic Services, an intelligence-gathering agency that was a forerunner of the CIA. P, When plans opt out: family planning family planning
Use of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources. access in Medicaid Medicaid, national health insurance program in the United States for low-income persons; established in 1965 with passage of the Social Security Amendments and now run by the Centers for Medicare and Medicaid Services. managed care, The Guttmacher Report on Public Policy, 1998, 1(4):8-11.
Gold RB, Conscience makes a comeback in the age of managed care, The Guttmacher Report on Public Policy, 1998, 1(1):1-2.
POLICIES ALLOWING PROVIDERS TO REFUSE ABORTION CONTRACEPTION Individual Individual STATE Providers Institutions Providers Alaska X Private Arizona X X Arkansas X X X California X Religious Colorado X X X Connecticut X Delaware X X Florida X X X Georgia X X Hawaii X X Idaho X X Illinois X Private X Indiana X Private Iowa X Private Kansas X X Kentucky X X Louisiana X X Maine X X X Maryland X X Massachusetts X X Michigan X X Minnesota X Private Mississippi X X X Missouri X X Montana X Private Nebraska X X Nevada X Private New Jersey X Private New Mexico X X New York X North Carolina X X North Dakota X X Ohio X X Oklahoma X X Oregon X Private Pennsylvania X Private Rhode Island X South Carolina X Private South Dakota X X Tennessee X X X Texas X Private Utah X Private Virginia X X Washington X X X West Virginia Wisconsin X X Wyoming X Private TOTAL 46 43 8 CONTRACEPTION STATE Pharmacists Pharmacies Institutions Alaska Arizona Arkansas X * Private California ([dagger]) Colorado * * Private Connecticut Delaware Florida * Georgia X Hawaii Idaho Illinois * ([double dagger]) X Indiana Iowa Kansas Kentucky Louisiana Maine * * Private Maryland Massachusetts Private Michigan Minnesota Mississippi X X X Missouri Montana Nebraska Nevada New Jersey ([PHI]) Private New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota X Tennessee * * Private Texas Utah Virginia Washington ([OMEGA]) X West Virginia Wisconsin Wyoming TOTAL 4 1 9 STERILIZATION Individual STATE Providers Institutions Alaska Arizona Arkansas X X California Colorado Connecticut Delaware Florida Georgia X X Hawaii Idaho X X Illinois X X Indiana Iowa Kansas X X Kentucky X Louisiana Maine Maryland X X Massachusetts X Private Michigan Minnesota Mississippi X X Missouri Montana X Private Nebraska Nevada New Jersey X Private New Mexico X New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania X Private Rhode Island X South Carolina South Dakota Tennessee Texas Utah Virginia Washington X X West Virginia X X Wisconsin X X Wyoming TOTAL 16 15 Note: Unless indicated, the right to refuse applies to all Institutions--private, religious and public. * A broadly worded refusal clause may apply. ([dagger]) Pharmacists have a duty to dispense valid prescriptions and can only refuse to dispense a prescription, including contraceptives, when their employers approves the refusal and the woman can still access her prescription in a timely manner. ([double dagger]) State regulation requires pharmacies to fill valid contraceptive prescriptions. ([PHI]) Pharmacies have a duty to fill valid prescriptions. ([OMEGA]) The policy in Washington that requires pharmacies dispense valid prescriptions and deliver FDA-approved drugs, such as Plan B, is not in effect pending the outcome of a court case.