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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 services or sterilization 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 or pharmacies 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.)

HIGHLIGHTS:

* 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.

* 8 states allow individual health care providers to refuse to provide services related to contraception

* 4 states explicitly permit pharmacists to refuse to dispense 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 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, 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 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 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.

Cohen 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 P, When plans opt out: family planning access in Medicaid 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.
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Publication:State Policies in Brief (Series)
Article Type:Statistical table
Geographic Code:1USA
Date:Apr 1, 2009
Words:1145
Previous Article:Restricting insurance coverage of abortion.
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