Religious Restrictions:
Refusals to Provide Care

Religiously-affiliated health care providers often insist on their “right” to refuse to provide any medical information or services that conflict with religious doctrine or their personal moral beliefs.

In fact, some federal and state policies do grant these health providers explicit government permission to refuse to provide certain types of care, while still remaining eligible for public funding and, in some cases, being protected from liability for any harm that might come to the patient as a result of the refusal.

Religious health providers refer to these government permission slips as “conscience clauses,” but patient advocacy groups have renamed them “refusal clauses” to better depict the negative effect on patients when their hospitals, physicians, pharmacists or other health providers refuse to provide care. (See NHeLP's  report "Health Care Refusals: Undermining Quality Care for Women" to learn more.)

The first refusal clause enacted in the United States was the 1973 Church amendment, named after its sponsor, U.S. Senator Frank Church. It permitted hospitals and individual providers to refuse to perform abortions or sterilizations. The clause specifically allows hospitals to continue to be eligible to receive government money, despite this refusal to provide care. Similar refusal clauses were also adopted on the state level and in some cases applied to contraceptive services as well.

As time has passed, more and more refusal clauses have been enacted, interfering with women’s access to the health care services that are best for them and their families. For example, in response to the move in many states to require employers to provide contraceptive coverage for their employees, some states granted broadly-worded exemptions allowing religiously-affiliated employers to exclude that coverage. In other states, such as New York and California, the exemptions were permitted only for what are known as “pervasively sectarian” organizations, meaning those that employ and serve primarily people of the same faith and have as their mission the inculcation of religious values. These narrower refusal clauses exempt diocese offices, seminaries and the like, but do not exempt religiously-affiliated colleges, hospitals or social service agencies which serve and employ many people of other faiths.

Catholic hospitals have also demanded exemptions from proposed state laws that would require the offering of emergency contraception to rape victims. In one state, Hawaii, the governor vetoed a so-called EC in the ER law because it did not include such an exemption. In other states, EC in the ER laws have been applied uniformly to all hospitals including those with religious affiliations (learn more at our EC in the ER page).

More recently, there have been proposed public policies to allow pharmacists to refuse to dispense contraception (four states have enacted such laws) and permit hospitals and health insurers to refuse to allow fertility treatments, embryonic stem cell research and certain end-of-life care choices. Some proposed refusal clauses are also broadening the definition of what constitutes “involvement” in health care services to potentially include the activities of such non-professionals as medical office assistants who schedule appointments. 1

MergerWatch monitors the spread of these refusal clauses and provides public education about the potential impact on patients’ rights and access to care. If a refusal clause is proposed in your state, let us know by contacting us.

  1. Sonfield, Adam. “New Refusal Clauses Shatter Balance Between Provider ‘Conscience,’ Patient Needs.” The Guttmacher Report. 2004 August.