On March 14, the Michigan Senate Health Policy Committee heard testimony regarding Senate Bill 136, the Religious Liberty and Consciousness Protection Act. If passed, the bill would “allow a health facility to assert as a matter of conscience an objection to participating in a health care service, and decline to participate in that service.” Such objections are most often issued in relation to abortion care or other reproductive health services. Associating “conscience” with not providing a service inherently neglects the fact that those who do provide those services may also be ethically driven. With this bias favoring moral objections over moral participation, how can this bill really be about “consciousness protection?” Instead, it’s an ill-begotten maneuver that threatens to subordinate patient care.
This is not to say that I believe health care providers should be forced to provide services to which they object. In fact, providers and institutions are already protected by the Church Amendment. This policy prohibits the government from requiring health care providers or institutions to perform or assist in abortion or sterilization procedures against their moral or religious convictions, and further protects discrimination against such conscientious objectors. With these basic provisions in place, the Michigan law seeks to expand protections from abortion and sterilization services to any practice, including the removal of a life-sustaining device. The bill ensures that providers who support objections have legal recourse, extends moral objections to “health care purchasers” and applies to education institutions.
The bill additionally mandates that medical facilities “adopt and implement a policy to address situations in which a health provider had an objection to participating in a health care service as a matter of conscience.” Written requests for accommodation and a process for granting or denying accommodation are suggested. However, objections will be disregarded if a “public health emergency” arises, no other provider is available to provide the requested service or the request is based on the patient. Of course these stipulations are subjective and are especially relevant to abortion care, considering that 87 percent of counties in the United States lack an abortion provider. If a privately practicing OB/GYN in the upper peninsula refuses to provide abortion care and the nearest clinic is a nine-hour drive away (considering costs of travel, lodging, taking time off of work/school and possibly child care), does that mean that “no other provider was available to provide that service?”
One way to remedy this problem might be to offer insurance subsidies to physicians who practice in rural areas, an incentive offered in Norway. Another option might be tele-medication, though House Bill 5711 outlawed this in Michigan. Finally, though providers are protected from discrimination, perhaps the accommodation process should be carried out proportionally to the demand for the services that would be denied to patients. For example, the reasons offered for objection to dispensing birth control by a pharmacist employed by the only pharmacy in a small, rural town should be more thoroughly examined than a pharmacist with a similar viewpoint who works in an urban area littered with options. When opting to decline a service, health care providers must reckon with the ramifications of their decision in order to ensure patient care is not subordinated.
Finally, I wish to contextualize this bill. Last year, the bill was dropped after the addition of an amendment that protected patients from discrimination based on status — race, religion, national origin, sex, sexual preference, etc. In its current state, SB 136 offers no comparable definition. Thus, it seems fair to assume that this bill will be abused as a mechanism to refuse not only abortion care and sterilization, but also in-vitro fertilization or HIV/AIDS treatment. Not only does this bill threaten to subordinate patient care, but, by its very nature, also threatens to permit discrimination.
Emma Maniere is an LSA sophomore.