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Testimony Re: Abortion Non-Discrimination Act

The Committee on Energy and Commerce
W.J. "Billy" Tauzin, Chairman
Subcommittee on Health
July 11, 2002
3:00 PM
2123 Rayburn House Office Building

Lynn D. Wardle, J.D.*

Prepared Witness Testimony

I. Introduction

Today a growing number of health care practices, procedures, and medications present serious moral concerns for many health care providers. Recent medical and pharmacological developments increasingly put health care entities at the vortex of some of society's most controversial moral dilemmas. These include issues relating to providing, performing, participating in or facilitating as abortion (both by traditional surgical methods and also by chemical methods such as the "Morning After Pill"), human cloning, embryonic stem cell techniques, genetic engineering including sex preselection, DNA screening for genetic disorders, sterilization, contraception, sex-change, euthanasia, assisted suicide, and capital punishment by lethal injection, to name just a few medically-related practices with profound moral implications. Increasingly there is pressure upon health care providers, both individuals and organizations (such as clinics, hospitals, practice groups, and insurers) to put aside personal moral beliefs in order to facilitate convenient access to new drugs, procedures, and technologies.

In the ordinary course of professional life, without any additional pressures, these dilemmas arise often enough to create crises for tens of thousands of health care entities. However, in addition to these dilemmas there is increasing pressures upon health care participants to facilitate or provide products or services which violate their own consciences. Advocates of particular procedures and programs, particularly major providers of promoters of abortion are systematically singling out health care providers and entities to squeeze and compel them to abandon their moral values as the price to pay to remain in the profession and market.

II. Overview of the Development of the Crisis of Conscience

I have closely studied abortion law and policy in the United States for thirty years, and have seen the transformation. Initially, advocates of permissive abortion argued that they merely desired to give women the private choice to select abortion. They asserted that they did not intend to force anyone to do anything, but only sought to repeal laws that prohibited one option - abortion -- that they believed should be available to pregnant women.

However, after that goal was achieved by judicial decree, it was not long before they demanded that public funds be available, that public hospitals should be forced to provide the service which they considered so desirable. In a series of cases, they repeatedly tried to get the Supreme Court to interpret the Constitution so as to invalidate laws that restricted public funding and provision of abortion in public hospitals. Fortunately, the U.S. Supreme Court turned them down every time. Sadly, a number of state courts have not been so fair, and have accepted these zealots' demands that the state constitutions be interpreted to judicially mandate public funding of abortion.

Then they tried to stop citizens who wished to exercise their right to peacefully assemble in opposition to abortion, and to punish individuals who tried to offer free, peaceful "sidewalk counseling" to pregnant women to advise them about alternatives to abortion. While the Supreme Court has invalidated many (but not all) of such laws and decrees, the effort to suppress pro-life free speech continues, led ironically by the same organizations that championed "the right to choose."

Just a few years ago, they attempted to enact regulations for accrediting medical schools and teaching hospitals to force medical students and young doctors to be trained to perform abortions. Congress had to step forward and pass a law to prevent that coercion and to protect the rights of conscience of medical students, doctors and hospitals.

Recently, there have been a series of attempts to compel hospitals, health care groups, and other hare care organizations to either provide abortion services or to be denied the license, permission or opportunity to engage in the health care service. Also, there have been attempts to mandate that health care insurers and private employers provide coverage and pay for abortion services.

The Supreme Court has declared that the Constitution protects private choice of abortion against state prohibition. The Court has emphasized that it does not compel public assistance, support or facilitation of abortion. The decisions can be read as neutrality decisions - the state must not use its power to coerce a decision one way or another regarding childbirth or abortion. The government may prefer, persuade, encourage, and promote one way or the other, but it may not compel.

The private choice to decline to participate in abortion deserves no less protection than the choice to participate in abortion.

Yet zealous abortion activists continue to try to use the powers of government to compel participation in and payment for and coverage of abortion. Specifically, they try to compel hospitals, clinics, provider groups, and health care insurers to provide facilities for, personnel for, and funding for abortion.

III. Examples of Abuses of Rights of Conscience

In repeated cases, pro-abortion extremists are trying (successfully in many cases) to assert the position that a health care entity who will not perform abortions must be denied access to the public market. For instance, currently there is a battle in New Jersey in which pro-abortion zealots are trying to stop the merger of a secular hospital with a religious hospital group because that will result in the hospital not performing abortions. Rather than helping some abortion clinic in the area to expand or operate more actively in the area, the pro-abortion zealots are taking the position that a hospital who does not perform abortion must be disqualified from participating in the health care profession.

In recent years, there have been a number of incidents involving apparent violations of the rights of conscience of health care workers in the United States. Well known is the attempt by the ACGME to require all Ob/Gyn residents in all Ob/Gyn programs be trained to perform abortions. During the 1999 California legislative session, a bill was introduced that would have, among other things, disallowed hospitals that decline to participate in abortion from receiving public financing or state-funded health care contracts. In Connecticut, after abortion rights activists learned that an outpatient surgical center proposed by four hospitals would not perform abortion and sterilizations, they formed a coalition to defeat the proposed center and intervened in Certificate of Need proceedings and the Connecticut Office of Health Care Access refused to issue a certificate. Incidents in which hospital mergers to help struggling hospitals survive have occurred in New Hampshire, Florida, and New York, as well. I cite just a few headlines from the Protection of Conscience website: "Nurse Refused Employment, Forced to Resign" (she refused to participate in abortions); "Worker fired for refusing payment for illegal abortion (refused to sign for welfare payment for abortion); "Hospital Aide Fired for Refusing to Clean Abortion Instruments"; "Kmart Pharmacist Fired for Refusing to Dispense Abortifacient" (other workers had done it for her); "Student pressured to participate in abortion"( in Saskatchewan, Canada, 1999); "Foothills Hospital Now Forces Nurses To Participate In Genetic Terminations" (nurses angry about being forced to participate in abortion of imperfect and late term babies); and "More DC Medics Say They Were Forced to Have Abortions." Michael Bloomberg, the new Mayor of New York, now compels abortion training as an "additional required component to OB/GYN residency programs in all New York City city-owned hospitals. The training is outlined in Michael Bloomberg's Blueprint for Public Health along with a proposal requiring victims of sexual assault to be given emergency contraception when taken to emergency rooms. Previously, only 2 out of the 11 public hospitals include abortion as part of their training. The training will teach OB/GYNs how to perform abortions and provide counseling." News reports say that Bloomberg's plan "allows residents who object to abortion on moral grounds to forego the training." But what pro-abortion politicians consider an appropriate exemption for rights of conscience often turns out to be mere eye wash, narrow, ineffective and cynical. "[T]he media mogul . . . reportedly once told a pregnant employee to "Kill it! Kill it!" (The comment, which Bloomberg has denied making, was cited in the legal papers of Sekiko Sakai Garrison, a former Bloomberg News staffer who brought one of three publicized sex-harassment cases against him or his company.)"

These examples reveal only the tip of the iceberg. A landmark empirical study of, inter alia, nurses attitudes about and difficulties encountered because of personal objection to abortion and other medical procedures in the 1980s revealed that approximately 5% of the nurses sampled (which extrapolated out would amount to approximately 50,000 nurses in the United States) perceived that their assignment and promotion opportunities may be limited by their moral and religious beliefs about abortion. The nurses in this sample "identified a total of 103 definite cases in which nurses had either been dismissed or had their opportunities limited because of moral beliefs. . . . [F]ifty-seven cases were identified in which the nurses beliefs about abortion had cost them opportunities for promotion or sustained employment." Moreover,

[a]pproximately 7% of Catholic nurses, 4% of Protestant nurses, and 6% of those belonging to 'other' religions indicated they knew at least one other person whose opportunities with hospitals had been limited by personal beliefs. . . . Thirty-six nurses [in the national sample] identified a total of 118 of their colleagues who had been limited as a result of their moral and religious beliefs.

IV. Existing Conscience Clause Protection Laws

These incidents attempt to circumvent existing laws enacted by Congress and 49 states enacted to provide some protection for the rights of conscience of health care workers in at least some situations. The laws, called "conscience clauses" generally are drafted to protect the right of health care professional to refuse to participate in providing a service or procedure to which they have religious or other moral objections. Conscience clauses have been enacted by both federal and state law makers. Sadly, many of these laws are outdate, addressing concerns that are nearly 30 years old, but not address the more recent threats to rights of conscience. Conscience clauses can be traced to a specific judicial decision that provoked a firestorm of controversy. In November 1972 a United States District Court in Billings, Montana issued an injunction forbidding a Catholic hospital to deny the use of its facilities to a physician who wanted to perform a sterilization on a patient there. The suit to enjoin the hospital was brought under 42 U.S.C. § 1983 and 28 U.S.C. § 1343, which provide redress for deprivation of civil rights under color of state law. The district court ruled that the fact that the hospital had received public funds under the federal Hill-Burton Act was alone sufficient to make the hospital a "state actor" for purposes of those civil rights statutes. The next year, in direct response to that ruling, and just months after the Supreme Court's decision in Roe v. Wade, Congress passed the Church Amendment, the original federal conscience clause, 42 U.S.C. § 300a-7, which was designed to prohibit a court or a public official from using receipt of federal grants or assistance under three specific acts, as a basis for requiring any individual or institution to perform or assist in performing abortions or sterilizations, if such would be contrary to religious or moral beliefs. Because of the Supreme Court decision in Roe effectively required all states to legalize nontherapeutic abortion on demand, the conscience clause movement became immediately relevant, and most states enacted conscience clauses to protect the right of at least some health care providers to refuse to perform or participate in abortions.

The Church Amendment is still the main federal protection for the rights of conscience of health care providers. Additionally, Title VII of the Civil Rights Act requires employers generally to accommodate the religious beliefs of their employees that do not cause undue hardship.

Also, in 1997 Congressional "amendments extend[ed] conscience protections to cover Medicaid and Medicare managed care plans, which may now refuse to 'provide, reimburse for, or provide coverage of a counseling or referral service if the . . . organization offering the plan . . . objects to the provision of such service on moral or religious grounds . . . .'"

Forty-nine states provide at least some protection for rights of conscience of some health care providers in some circumstances. (Only Vermont has no statutory protection for rights of conscience whatever.) However, only one state, Illinois, has a comprehensive conscience protection law that covers all health care providers, institutions, and payers and applies to all health care services. One other state, Washington, protects the right of conscience to refuse to participate in any health care services and covers all individuals but only religiously-affiliated institutions.

Abortion is the focus of most conscience clauses. Forty-five states allow some health care workers to refuse to participate in abortions. Twenty-five states' conscience clauses cover only abortion. Ten states allow health care workers to exercise their right of conscience to not participate in abortion only if working for individuals or private institutions. Two states conscience protection laws cover abortion but apply only when the health care provider is an individual, and one other state has a similar restriction covering sterilization also. Four states cover specifically abortion and contraception. One state covers health care providers regarding abortion, sterilization and artificial insemination, and another covers only abortion, abortifacients, and sterilization. At least three states (California, Mississippi and New Hampshire, and I suspect more but have not done the research) protect a right of health workers to decline to participate in some end-of-life decision implementations in limited circumstances. Two states cover counselors and social workers in some contexts. One state protects the right of pharmacists to not participate in abortion, assisted suicide and euthanasia. Eleven states protect the rights of conscience of medical and nursing students in some situations. Only nine of the sixteen states that mandate health insurance plans to include contraceptive drugs or devices if prescription drugs are covered contain any conscience clause provisions (usually limited to religious employers).

Existing conscience clause laws are inadequate as drafted for at least five major reasons. First, most are very narrow in terms of the practices, procedures or contexts in which they apply - most were drafted with abortion and sterilization in mind and go no further. Second, many of them are very narrow and restrictive, covering only a small group of health care providers, not workers in the health care industry generally. Third, the scope of protection (the discrimination forbidden) is limited. Fourth, the remedies and procedures for vindicating the rights are undeveloped and restricted. Fifth, most of the laws are outdated, having been written before many of the medical developments occurred that have created some of the most difficult moral dilemmas.

V. Hostile Interpretations

In addition to the deficiencies of drafting, there are problems of interpretation. Judicial interpretation of these statutes has been very grudging, even hostile. In contrast to how civil rights laws in general have been construed during the past thirty years, conscience clauses have received very cold, unsympathetic, unsupportive reception by state and federal judges. Judges have given narrow, hostile interpretation regarding procedures covered, persons covered, protections provided, and have casually circumvented the laws by invoking other laws.

In the limited time available to me, I cannot adequately convey the hostile tenor of most of the cases interpreting conscience clauses. Let me just give you a few selected examples. For example, in Browhfield v. Daniel Freeman Marina Hospital. In that case, a rape victim asked an emergency room worker at a Catholic hospital about the availability of the "morning after" pill. The worker declined to give any information because of her religious beliefs. The patient brought suit against the hospital, and the hospital raised the California conscience clause in defense. That statute provided that "no nonprofit hospital or clinic which is organized or operated by a religious corporation . . . or its administrative officers, employees, agents or . . . governing board shall be liable . . . for failure or refusal to perform or to permit the performance of an abortion in such facility or clinic or to provide abortion services."

Thus, the case turned on whether the morning after pill produced abortion. Finding no definition of "abortion" in the statute, the court made no effort to discern legislative intent (specifically, regarding the morning after pill, or generally, regarding protecting conscience rights of health care providers), and made no effort to interpret the statute in light of the policy underlying the statute or to achieve integrity within the structure of the provision, or to determine as a matter of judicial notice whether the morning after pill was understood by the medical community or the Catholic medical community to cause abortion. Instead, citing dicta in another case suggesting that at least one federal court did not consider the morning after pill to be an abortifacient, the California court summarily concluded that the hospital's refusal was not protected because the morning after pill did not cause abortion.

While the conclusion of the court that the morning after pill does not cause abortion in at least some cases is probably inaccurate, the method of statutory construction is even more disturbing. The question the court had was one for which a resort to random dicta in other cases giving unsupported judicial ruminations in the context of interpreting entirely different statutes enacted by a different government is not an intelligent approach to legislative interpretation. The Brownfield case is an example of how judges can manipulate the interpretation of a statute to reach the outcome they prefer for personal or ideological reasons. Thus, it illustrates an unfortunate but very real risk for those who try to rely upon the current generation of conscience clauses.

In Spellacy v. Tri-County Hospital, Pennsylvania courts held that a part-time admissions clerk who claimed that she was fired by the hospital as a result of her refusal to participate in the admission procedures of abortion patients was not protected by the state's conscience clause because her position was one of mere "ancillary" or "clerical" assistance.

Likewise, in Erzinger v. Regents of University of California, the California Appellate court noted: "The proscription only applies when the applicant must participate in acts related to the actual performance of abortions or sterilizations. Indirect or remote connection with abortions or sterilizations are not within the terms of the statute."

The same bias is reflected in the dissenting opinion of two Montana Supreme Court justices in Swanson v. St. John's Lutheran Hospital. That case involved a wrongful discharge action brought by a nurse-anesthetist who had worked at a hospital for eight years. She had performed more than two dozen sterilizations, but after participating in one particularly shocking and gruesome abortion, she informed her supervisor that she would not participate in any more sterilizations. The hospital administrator tried to change her mind, referred her to her priest, and called the priest to ask him to counsel her to change her mind. She remained fixed in her decision, and the next day was fired by the hospital administrator. She brought suit under Montana's conscience clause, which protects the rights of individuals to refuse on moral or religious grounds to perform sterilizations, and prohibits employment discrimination based on such refusals. After a harrowing encounter with a hostile Montana trial court, she ultimately prevailed in the Montana Supreme Court. However, two of the Montana Supreme Court justices would have denied her claim on the ground, inter alia, that her reasons for refusing to participate in any more sterilizations were emotional rather than moral. By contrast, in a case interpreting a conscience clause that protects the right of physicians from employment discrimination because they have performed abortions or sterilizations, a pair of federal courts did not require any evidence about the moral or religious basis for a doctor's practice or sterilizations. See Watkins v. Mercy Medical Center, 364 F. Supp. 799 (D. Ida. 1973), aff'd, 520 F.2d 894 (9th Cir. 1975). There appears to be at least a hint of anti-Catholic, anti-prolife bias in the way the conscience clauses have been interpreted. See also In Re Raquena, 517 A.2d 886,891 (N.J. Super. 1986) (lecturing Medical Center that unwillingness to participate in withdrawal of life-support food/hydration systems was not "pro-life", and requiring the hospital to participate in the withdrawal over its and staff's moral objections). See further infra notes __ through __ and accompanying text.

In Catholic Charities of Sacramento, Inc. v. Superior Court, a Catholic charitable organization was held not to qualify for the "religious employer" exemption from a California statute requiring employer to provide prescription contraceptives in benefits package, and was also denied constitutional protection from that requirement which violated basic Roman Catholic doctrine. .

In Valley Hosp. Ass'n, Inc. v. Mat-Su Coalition for Choice, the Alaska Supreme Court held that that state's conscience clause was unconstitutional to the extent it applied to allow a private nonprofit hospital that was the sole hospital in the Mat-Su valley to refuse to provide abortions because it was a de facto quasi-public institutions.

In Larson v. Albany Medical Center, a New York state appellate court held that employees fired in alleged retaliation for exercising rights protected under the state conscience clause had not no private right of action.

VI. The History of Protection of Conscience in America

The history of protection of conscience in America is directly relevant to the protection of rights of conscience of health care providers in three ways. First, protection for rights of conscience underlie and historically preceded the First Amendment. In June, 1776, even before the Declaration of Independence, the Virginia Declaration of Rights provided, inter alia, that "all men are equally entitled to the free exercise of religion, according to the dictates of conscience . . . ." After centuries of government support for the state church in Virginia, the Baptists led a petition campaign demanding that "every tax upon conscience . . . be abolished." In 1779, Thomas Jefferson introduced his Bill for Establishing Religious Freedom in the Virginia Legislature (House of Burgesses). It declared that "to compel a man to furnish contributions of money for the propagation of opinions which he disbelieves, is sinful and tyrannical." (If Jefferson thought that about merely funding things against ones will, one can imagine what he would say about being compelled to perform acts or services like abortion or the MAP against one's conscience.) Jefferson's Bill did not pass for over six years, but in December, 1785, while Jefferson was Minister to France, James Madison engineered passage of Jefferson's Bill. As finally enacted it declared that "no man shall be . . . molested or burdened in his body or his good, nor shall otherwise suffer on account of his religious opinions or belief . . . and that the same shall in no wise diminish, enlarge or effect their civil capacity." So proud was Jefferson of his role in securing protection for rights of conscience that he asked that his gravestone be inscribed: "Thomas Jefferson, Author of the Declaration of Independence, of the Statute of Virginia for Religious Freedom, and Father of the University of Virginia."

Second, it is critical to understand that in America in the 1770s and 1780s two different views about matters of conscience and religion were competing. One view, with a high and honorable heritage traceable to John Locke's famous essay, A Letter Concerning Toleration, viewed accommodation of religious variety and differences to be a matter of utilitarian toleration or accommodation. In some of his early writing, at least, Thomas Jefferson advocated this approach. Respect matters of conscience and religion as simply a matter of toleration - sound public policy, good neighborliness and good Polistes. On the other hand, the Virginia Baptists and most famously, James Madison, spoke of matters of conscience and religion not merely as toleration but as fundamental, natural rights. It makes a big difference whether respect for another's moral convictions is given simply as a matter of convenience and tolerance (to be suspended when outweighed by other political considerations, for example, in time of emergency), or whether that is a matter of your neighbor's basic civil rights. Fortunately, the Founders ultimately concluded that protection for conscience was a matter of fundamental right. Early colonial charters and state constitutions spoke of it as a right, and during the frightening emergency of the War of Independence, rather than suspend respect for divergent moral views, many states granted exemptions from conscription to persons with religious scruples against war, such as Quakers and Mennonites. In 1775, the Continental Congress granted a general exemption from military conscription to religious groups. The Virginia Declaration of Rights was initially drafted too guarantee "fullest toleration" of religion; but Madison amended it and when it passed, it protected the rights of religion: "all men are entitled to the full and free exercise of it according to the dictates of conscience." Madison's Memorial and Remonstrance expressed the language of rights, not toleration ("The equal right of every citizen to the free exercise of his Religion according to the dictates of conscience is held by the same tenure with all our other rights." Of course, the best example is the protection of conscience as a right is inclusion of the right to free exercise of religion in the First Amendment of the Bill of Rights. (James Madison, of course, was the Father of the Bill of Rights.) Ironically, some courts and most commentators today have slipped into using the language of toleration and accommodation. It is time for us to reassert emphatically the language of rights.

Third, when an effort to revive the religion tax in Virginia was made after the War of Independence, James Madison drafted his famous Memorial and Remonstrance declaring that certain things like religious duties "must be left to the conviction and conscience of every man; and it is the right of every man to exercise it as these may dictate." He explained why:

Before any man can be considered as a member of Civil Society, he must be considered as a subject of the Governor of the Universe: And if a member of a Civil Society, who enters into any subordinate Association, must always do it with reservation of his duty to the general authority; much more must every man who becomes a member of any particular Civil Society, do it with a saving of his allegiance to the Universal Sovereign.

Madison clearly understood that if men are not loyal to themselves, to their conscience, to their God and their moral duty as they see it, it is utterly irrational folly to expect them to be loyal to less compelling moral obligations of legal rules, statutes, judicial orders, or the claims of citizenship and civic virtue, much less professional duties. If you demand that a man betray his conscience, you have eliminated the only moral basis for his fidelity to the rule of law, and have destroyed the foundation for all civic virtue.

Finally, the loss of virtue that results from requiring men to violate and disregard their conscience undermines the basis for self-government. The founders of the American Constitution really believed that virtue in the citizenry was absolutely essential, indispensable for this system of government to function and survive. I have brought just a few quotes from the Founders to make this point.

Thomas Jefferson: "[O]ur rules can have authority over such natural rights only as we have submitted to them. The rights of conscience we never submitted, we could not submit. We are answerable for them to our God."

George Washington: "Tis substantially true, that virtue or morality is a necessary spring of popular government. -- The rule indeed extends with more or less force to every species of Free Government.-- Who then is a sincere friend to it, can look with indifference upon attempts to shake the foundation of the fabric? --. . . ."

Samuel Adams agreed that "neither the wisest constitution nor the wisest laws will secure the liberty and happiness of a people whose manners are universally corrupt."

James Madison told delegates to Virginia's ratifying convention: "To suppose that any form of government will secure liberty or happiness without any virtue in the people, is a chimerical idea." He also wrote in Federalist No. 57: "The aim of every political Constitution is or ought to be first to obtain for rules men who possess most wisdom to discern, and most virtue to pursue, the common good of society; and in the next place, to take the most effectual precautions for keeping them virtuous whilst they continue to hold their public trust."

John Adams clearly warned: "Out constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other." He also said: "Liberty can no more exist without virtue and independence than the body can live and move without a soul."

Thus, protection of conscience has been crucial to the foundation of this nation.

VII. Conclusion

This Energy and Commerce Committee has recently be involved in hearing testimony about enormous scandals caused because businessmen and accountants and other professional have anesthetized their consciences in the pursuit of wealth. The consequences have been seedy, shady, and disastrous for the companies and for the economy of the country.

In this context, it is more than a little ironic to hear abortion zealots plead that Congress must look the other way while they continue to coerce health care professionals and entities to ignore their consciences. The results of not protecting and encouraging the exercise of conscience in the health care profession will be just as disastrous as it has been for Enron and Worldcom and perhaps for Martha Stewart.

Currently pending in Congress is the Abortion Non-Discrimination Act. It is a very small, but very important step in the right direction. It simply protects conscience by requiring modest accommodation for entities that cover and pay for and provide medical services. It merely prohibits use of state power to coerce abandonment of conscience and moral principles. It is a true neutrality provision, guaranteeing each health care participant the right to choose for himself or herself or itself to follow the values and moral precepts they espouse.

I urge this Committee to act promptly to enact the Abortion Non-Discrimination Act and other acts which will address the crisis of conscience and begin to eliminate the intolerance, coercion and discrimination against health care participants who do not believe in participating in the provision of abortion and other morally controversial procedures.


Attachment to Statement of Lynn D. Wardle
Summary of State Laws Protecting Rights of Conscience
July 8, 2002
Alabama

Code of Ala. § 22-8A-8 (2001) No nurse, physician or healthcare provider is required to withdraw life-sustaining treatment. Health care provider will attempt to transfer patient to other provider.

Alaska

Alaska Stat. § 18.16.010 (b) "Nothing in this section requires a hospital or person to participate in an abortion, nor is a hospital or person liable for refusing to participate in an abortion under this section."

Arizona

A.R.S. § 36-2151 Hospital, physician or other medical personnel may refuse to perform an abortion for moral or religious reasons.

Arkansas

A.C.A. § 20-16-304, 601 (2001) No person or hospital has to participate in an abortion. Medical personnel may refuse to give contraceptives or information about such things if it is against their religious beliefs.

California

Cal. Health & Safety Code 123420 A physician, nurse or other hospital employee may refuse to participate in an abortion for moral or religious reasons. Admission to a school may not be denied due to applicant's unwillingness to participate in an abortion. Non-profit facility or religious hospitals do not have to perform abortions.

Colorado

C.R.S. 18-6-104 (2001) Hospital does not have to admit a person for the purpose of performing an abortion. A person who is an employee at a hospital does not have to perform an abortion if it is against his morals or religious principles.

C.R.S. 25-6-102, 207 (2001) No private institution or physician is required to give out contraceptive. A county or city employee may refuse the duty to supply contraceptives.

Connecticut

Conn. Gen. Stat. § 19a-580a (2001) Any physician who does not wish to comply with a living will must transfer the patient.

Delaware

24 Del. Code Ann. 1791 No person is required to participate in an abortion. No hospital has to participate.

Florida

Fla. Stat. § 390.0111 (2001) Hospital and person do not have to participate in abortion if it against moral or religious principles.

Fla. Stat. § 381.0051 (2001) Physician or other person may refuse to give contraceptives for medical or religious purposes.

Georgia

O.C.G.A. § 16-12-142 (2001) No person or hospital shall be required to perform an abortion when it is against his moral or religious principles.

O.C.G.A. § 49-7-6 (2001) Any employee can refuse to provide family planning services if it is contrary to his religious beliefs

Hawaii

H.R.S. § 453-16 Nothing in this section shall require any hospital or any person to participate in such abortion nor shall any hospital or any person be liable for such refusal.

Idaho

Idaho Code § 18-612 (2002) No hospital or person shall be required to perform an abortion if it is objected to for moral reasons.

Illinois

745 ILCS 70 - Rights of Conscience are protected for all procedures. Sec. 11.2 - Health Care Payers are not liable. Sec. 12 - Right to recover treble damages, may not be less than $2,500.

Indiana

Ind. Stat. 16-34-1-3 to 5. No hospital shall be required to perform an abortion. No person shall have to do so if it against his moral or religious principles and one cannot be required to participate in an abortion as a condition of training or employment.

Iowa

Iowa Code § 146.1&2 (2002) No person shall be required to perform an abortion if it against his moral or religious convictions. No hospital that is not maintained by public authority must perform an abortion.

Kansas

K.S.A. § 65-443, 444 (2001) No person or hospital is required to perform an abortion. Refusal to do so is not grounds for civil liability against any person.

Kentucky

KRS § 311.800 (2001) No public funds shall be used to perform an abortion. No private hospital or person shall be required to perform an abortion.

Louisiana

La. R.S. 40:1299.31 to .32 (2002) No person in the medical field can be liable for refusing to participate in abortion. No social service worker is liable for refusing to recommend abortions. No hospital shall be required to perform an abortion.

Maine

22 M.R.S. § 1591-2 (2001) no person or hospital is required to perform an abortion. No hospital, firm, or education institution can discriminate for a person's refusal to perform an abortion.

22 M.R.S. § 1903 (2001) A private institution or physician or their agent may refuse to provide family planning services if it is against their religious or moral beliefs.

Maryland

Md. Health-General Code Ann. § 20-214 No person or hospital has to participate in an abortion, artificial insemination, or sterilization. There is no immunity if a person's referring the patient to a source of pregnancy termination would have prevented death or long lasting injury.

Massachusetts

Mass. Ann. Laws ch. 112, § 12I (2002) Any person who objects to abortion or sterilization will not be required to participate. Such an objection will not be used against a person to keep him out of medical school, social work, etc.

Michigan

MCLS § 333.20181, 20182 (2002) No hospital, teaching institution or person connected with such a facility is required to perform an abortion if objected to on professional, moral, or religious grounds.

Minnesota

Minn. Stat. Ann. 145.414, 145.42 No hospital or person is liable if they refuse to participate in an abortion. No health Plan company will be held liable for not providing abortions.

Mississippi

Miss. Code Ann. § 41-41-215 "A health-care provider may decline to comply with an individual instruction or health-care decision for reasons of conscience."

Missouri

§ 197.032 R.S.Mo.No person or public or private hospital shall be required to treat a person for abortion.

§ 188.110 R.S. Mo. (2001) No employer can discriminate against employees for their refusal to participate in an abortion.

§ 188.110 R.S.Mo. (2001) No school can deny admittance for a person's refusal to participate in an abortion

Montana

Mont. Code Anno., § 50-20-111 (2001) No private hospital need provide abortion. All persons have the right to refuse or participate in an abortion. Person can mean individual or corporations.

Mont. Code Anno. § 50-5-502 to 505 No hospital or medical facility or persons shall have to perform sterilization. Person has the right to injunctive relief or monetary damages. Hospital or medical facility shall not loose any privileges or immunities.

Nebraska

Neb. Rev. Stat. ' 28-337 No hospital in the state, public or private, must perform an abortion, but it must inform the patient of this policy.

Nevada

Nev. Rev. Stat. 632.475 - Nurse or somebody providing direct assistance to a patient does not have to assist in an abortion if it is against her morals

New Hampshire

RSA 137-H:6 (2002) A physician who, for conscience sake, cannot comply with a living will shall without delay transfer the patient to another physician.

New Jersey

N.J. Stat. § 2A:65A-1 "No person shall be required to perform or assist in the performance of an abortion or sterilization."

N.J. Stat. § 2A:65A-2 "No hospital or other health care facility shall be required to provide abortion or sterilization services or procedures.

N.J. Stat. § 2A:65A-2 No civil liability for those who refuse to perform abortion or sterilization.

New Mexico

N.M. Stat. Ann. § 30-5-2 (2001) No person or hospital has to participate in abortion for moral or religious reasons

N.M. Stat. Ann. § 24-8-6 (2001) No hospital is required to admit a patient for sterilization if done so on religious grounds.

New York

NY CLS Civ R § 79-i (2002) No person shall be required to perform an abortion if it is against his conscience or religious beliefs.

North Carolina

N.C. Gen. Stat. § 14-45.1 Physician or nurse do not have to perform abortion if it is against their religious principles. A hospital or healthcare institution does not have to offer abortions.

North Dakota

N.D. Cent. Code, § 23-16-14 (2002) No hospital or person shall be required to perform an abortion.

N.D. Cent Code 14-02.4-15.1 (1997) Government may not discriminate against health care institute or private agency for refusal to participate in any health care service that is against written religious and moral policies.

Ohio

ORC Ann. 4731.91 (Anderson 2002) No public or private hospital or person has to participate in an abortion.

Oklahoma

63 Okl. St. § 1-741 No Private hospital or person has to participate in an abortion.

Oregon

Or. Rev. Stat. ' 435.485 (2001) No physician must give advice to a patient concerning abortion, but he must advise the patient. No hospital employee is required to participate in an abortion.

Or. Rev. Stat. § 435.225 (2001) "Any employee of the Department of Human Services may refuse to accept the duty of offering family planning and birth control services" if it conflicts with religious principles.

Pennsylvania

18 Pa. C. S. §3202 (2002) Right of Conscience is protected for all person who desires to not provide an abortion.

18 Pa. C.S. § 3213. Except for a facility devoted to abortions, no facility is required to perform abortions, and no medical personnel, employee or student is required to participate in an abortion. Civil Liability may reach $5,000.

43 P.S. § 955.2 (2002) No hospital or person is required to perform an abortion or sterilization. No school can deny admission due to a person's refusal to participate in abortion or sterilization.

Rhode Island

R.I. Gen. Laws § 23-17-11 (2001) No person shall be required to participate in an abortion or sterilization if such are objected to on moral or religious grounds.

South Carolina

S.C. Code Ann. § 44-41-40 (2001) No private institution is required to perform an abortion.

South Dakota

S.D. Codified Laws § 34-23A-12 (2001) No person who refuses to perform an abortion shall be held liable.

Tennessee

Tenn. Code Ann. § 39-15-204, 205 (2001) No hospital or person need provide an abortion.

Tenn. Code Ann. § 68-34-104 No private institution or physician is required to provide contraceptive procedures or supplies if refusal is based on conscientious or religious objections.

Texas

Tex. Occ. Code § 103.001, 002 (2002) No physician, nurse or employee of a hospital maybe required to participate in an abortion.

Tex. Occ. Code § 103.003 (2002) A person whose rights are violated may sue the hospital, medical facility or educational institution for an injunction plus affirmative relief, including reinstatement, backpay plus 10%

Tex. Occ. Code § 103.004 Hospital need not provide abortions.

Tex. Ins. Code Ann. art. 20A.09(m) - No, HMO, physician, or provider is required to recommend or provide services that violate religious convictions.

Utah

Utah Code Ann. § 76-7-306 (2001) No person shall be required to perform an abortion if it is against his moral or religious beliefs. No private or denominational hospital shall be required to perform abortions.

Virginia

Va. St. § 18.2-75 A hospital, medical facility or physician do not have to perform abortion.

Washington

Wash. Rev. Code Ann. 70.47.160 (2002) No HMO need provide or pay for services that are religiously objectionable.

Wash. Rev. Code Ann. § 70.122.060 (2002) . No nurse, physician, or other health care practitioner may be required by law or contract in any circumstances to participate in the withholding or withdrawal of life-sustaining treatment if such person objects to so doing

West Virginia

W. Va. Code § 16-2F-7 (2001) - No person need participate in and abortion if they refuse for medical reasons or any others.

W. Va. Code § 16-2B-4 (2001) Any employee of the state may refuse the duty of providing family planning services.

W. Va. Code § 16-30-12 A health care facility does not need to change it policies that are grounded in sincerely held religious convictions or moral principles. . . .A health care provider need not provide service that is contrary to its religious beliefs. (Living Wills etc.)
Wisconsin

Wis. Stat. § 253.09 (2001) No hospital or person is required to participate in abortion or sterilization.

Wyoming

Wyo. Stat. § 35-6-105, 106 (2001) No private hospital or institution or person need provide or participate in abortions. (Also mentions Euthanasia, but appears to be in context of abortion.)

Wyo. Stat. § 42-5-101 (2001) Any person may refuse the duty of providing family planning or birth control services if done so for religious or personal beliefs.