State Sen. Dave Murman of Glenvil introduces legislation to protect health care workers’ “right of conscience” on Friday, Feb. 10, 2023, in Lincoln, Neb. (Zach Wendling/Nebraska Examiner)
LINCOLN — A revived legislative proposal would protect health care providers’ “right of conscience,” allowing physicians to decline to provide a service if it would violate their beliefs.
Legislative Bill 810, proposed by State Sen. Dave Murman of Glenvil, would adopt the “Medical Ethics and Diversity Act,” defining a “right of conscience” violation as a service a provider objects to based on moral, religious or ethical beliefs.
Murman told the Health and Human Services Committee on Friday that his legislation is focused on individual services, not patients. So if providers offer a service to some, they must offer it to others.
The bill would only apply to non-emergent care.
“This legislation recognizes that those serving in health care are moral agents,” Murman said. “They are individual and personal human beings with consciences that deserve protection.”
Testifiers said the legislation could apply to abortion, physician-assisted suicide, gene editing, gender-affirming care, counseling for LGBTQ Nebraskans and more.
Murman introduced similar legislation in 2022 but it did not leave committee.
Any practitioner ‘who has a conscience’
Dr. Dale Michels, a retired family physician and the Nebraska representative of the American Academy of Medical Ethics, said professionals should be able to act on their deeply held beliefs to determine the correct course of care, not just if the care is legal.
“This is a good bill that will take any health care practitioner who has a conscience, which means it will protect every health care practitioner,” Michels said.
Michels said he used to prescribe IUDs to women but eventually stopped after doing more research. He said patients can usually find someone else to give the care regardless.
Dr. Lloyd Pierre, who co-founded a faith-based health clinic in Omaha, said the right of conscience in the medical field is as fundamental as those for speech, religion and the press.
Pierre said he was “shocked” to learn that some medical schools no longer require doctors to take the Hippocratic Oath to do no harm and that science and that some providers’ conscience rights were no longer priorities, which he said has led to fewer medical students entering the field.
He pointed to the torture of Jewish people during the Holocaust and to experiments on Black men with syphilis as extremes when doctors do not follow ethical practices.
“Removing people’s right to freedom of conscience opens the doors to a holocaust,” Pierre told the committee.
Dr. David Hilger, a diagnostic radiologist, said conscience is formed by physicians’ values, medical knowledge and experience, and it’s impossible to separate those.
When situations are complex or unclear in medical science, Hilger said clinicians differ in their responses, and conscience becomes “essential” in times of uncertainty.
‘Duty’ to facilitate care
Dr. Leslie Spry, representing the Nebraska Medical Association, said doctors have a “duty” to facilitate care, which includes arranging for care.
The bill does not require doctors to refer patients to another provider but does require the “prompt” transfer of patient records.
Spry said the referral must be to a specific entity, such as the medical association or trusted physician.
“If I just turn that patient away and say, ‘I can’t do this,’ I’m not caring for that patient,” Spry said.
Murman said he would continue working with the medical association on an amendment to address referrals.
Dr. John Trapp, chief medical officer of Bryan Medical Center, who testified representing the Nebraska Hospital Association, said that rights of conscience are already respected and that there is a process hospitals go through.
“I ask that you do not take action on LB 810, allowing hospitals and medical professionals to continue their great work unencumbered by state statutes such as this,” Trapp said.
Should the bill pass, Trapp said, the “unnecessary government oversight” would create more problems than it hopes to solve.
‘Line in the sand’
The bill lacks a specific list of services that could fall under its definitions, which Stephanie Nichols, legal counsel for the Alliance Defending Freedom, said is by design.
Nichols said health care is rapidly changing, so any list could become obsolete. She pointed to gene editing, which has grown in prevalence recently but was not as prevalent when the first right of conscience bill was approved in Illinois in 1977.
Mississippi adopted legislation in 2004, while Arkansas, Ohio and South Carolina adopted right of conscience bills in the past two years. Nichols said nearly a dozen bills are being considered around the country this year, including in Nebraska, Texas and Florida.
“The conscience bills work by drawing a line in the sand that conscience needs to be respected and that institutions, patients and doctors are able to work together to this end,” Nichols said.
Dr. Edward DeSimone, a pharmacist, said conscience rights should include whether pharmacists are required to give medications such as abortifacients or opioids.
Dr. Elizabeth Heidt Kozisek, a clinical psychologist, said mental health providers need protection, too, or patients could receive worse care from providers who violate their beliefs.
‘Dysfunctional’ health care
Dr. Echo Koehler, representing the Nebraska Nurses Association, said the bill could lead to “dysfunctional” health care delivery and could “compromise” quality of care.
“No patient should ever be obstructed from receiving legal health care based solely on a provider’s personal biases,” Koehler said.
She added that the legislation could also further harm marginalized communities, such as LGBTQ, low-income or people from racial or ethnic minorities.
Jane Seu of the ACLU of Nebraska, Abbi Swatsworth with OutNebraska, Nyomi Thompson of I Be Black Girl, Lacie Bolte of the Nebraska AIDS Project and Sarah Maresh with Nebraska Appleseed echoed Koehler’s comments.
“Let’s do what we can to ensure that all Nebraskans regardless of background or circumstance have access to the best possible health care,” Seu said.
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