Hank Stern has weighed in on a very touchy subject over at InsureBlog, and I’m inspired to add my thoughts. He wrote about the removal of the “moral exemption” clause that currently allows medical providers and pharmacists to refuse to perform procedures or dispense medications that would conflict with their moral beliefs. Apparently some people are speculating that this could cause a good number of doctors to leave the profession and hospitals to close up shop. I’m with Hank in thinking that this is probably an exaggeration. I can imagine that some doctors might quit in protest, and I can also imagine the Catholic church deciding to sell their hospitals and get out of the business. But someone would buy those hospitals, and they would continue to operate, unchanged for all practical purposes (but with a wider range of reproductive services available). Last year, the purchase of two Colorado hospitals by the Sisters of Charity of Leavenworth was met with much resistance by the hospital boards, specifically because of concern for how the sale would impact reproductive services for the community.
My own thoughts on this issue lie somewhere in the middle. I believe that each of us has to make our own choices when it comes to reproduction. Some people want ten children, some want none. Some want children right now, some would rather wait ten years. Sometimes the reproductive health issue is forced on a person when she least expects it, in the case of a rape. There’s no one-size-fits-all here. The same is true for medical providers. Some are quite comfortable performing abortions, tubal ligations, vasectomies, and prescribing RU-486 (and nearly all gynecologists will prescribe birth control pills and insert IUDs). Some are happy to counsel patients about family planning and provide birth control options, but would be loathe to perform abortions. And some would rather stay away from the whole family planning issue.
I would hate to see a mandate that requires doctors to perform abortions against their will. Hank makes a good point when he notes that this is not necessarily the outcome that would result from the removal of the conscience clause. But think about it – would you want to be the next patient scheduled after your doctor was forced to perform an abortion? I can’t imagine that would be beneficial for the doctors or the patients involved.
Instead of focusing on requiring doctors to provide medical services that go against their moral beliefs, why not work to make sure that every community has providers who can and will perform a wide range of reproductive services? If clinics like Planned Parenthood get adequate funding, doctors practicing nearby could continue to invoke the conscience clause without depriving the community of medical services. In metropolitan areas, there are plenty of doctors. I think that as long as a doctor is willing to provide a referral to another provider who will perform the requested services, there is no reason to require doctors to perform services to which they are morally opposed. Where this becomes an issue is in rural communities where there are far fewer medical providers. But again, instead of forcing doctors to perform services, I think that the public would be better served with the addition of a provider willing to provide complete reproductive care. For areas with populations too small to support the addition of another provider or clinic, a rotating clinic could be introduced, with a doctor who travels among several communities.
The need for a complete range of reproductive care isn’t going to go away. But there is a middle ground between letting doctors refuse services without regard for where the patient can go to obtain them, and forcing doctors to perform services against their will.
I found Hank’s article in the Cavalcade of Risk, hosted by Jason Shafrin at the Healthcare Economist. Our article about expanding existing public health insurance programs in Colorado was included in this week’s edition.