Risks Eyed in Drive for Health Access
The Catholic Sentinel
(Portland, Oregon, USA)
9 February, 2006
Reproduced with permission
"Protecting the conscience rights of physicians and
health care providers is essential to any proposed constitutional amendment
that seeks to establish access to health care as a 'fundamental right,'"
says a statement from the guild's president, Dr. Lynne Bissonnette. "The
conscience rights of physicians and health care providers cannot be deferred
for later inclusion in statutory legislation."
For more than 40 years, Catholic leaders have upheld the idea of health
care as a basic right.
But a proposal possibly headed to the Oregon ballot leaves too much
unsaid and could imperil the rights of providers who object to some
procedures, say two Oregon medical groups.
Initiative Petition 40 would amend the state constitution, creating
"access to effective and affordable health care as a fundamental right." The
plan, which needs more than 100,000 signatures by July to become Measure 40
for the November ballot, does not offer detail, but orders the Legislature
to craft a plan by July 2009.
As of the end of January, the drive had 14,000 signatures in hand. Chief
petitioners are Rep. Mitch Greenlick, D-Portland, Sen. Alan Bates, D-Ashland
and Sen. Ben Westlund, R-Tumalo.
Teams of Catholic physicians, as well as the Oregon Catholic Conference,
say the petition's lack of upfront conscience protection pollutes the goal
of expanded access.
Some doctors fear a future in which they could be charged with
unconstitutional acts if they refuse to perform an abortion, will not
participate in assisted suicide, or don't provide treatments using stem
cells taken from embryos.
"Getting every person health care is a matter of human dignity," says Dr.
Charles Bentz, an internist at Providence St. Vincent Medical Center and
president of Physicians for Compassionate Care. "The problem is that there
really needs to be a conscience clause. And there needs to be debate about
what is legitimate medical practice. Medical providers need to have a choice
about what they do and what they don't do. We also need to protect Catholic
health care institutions in what they cover and don't cover."
Dr. Bentz argues that the conscience clause should be included at the
start of the process, not later.
"Once you have a change in the constitution, it is very hard to come back
and fix things," he says. "The time is early on. You can't nip this kind of
thing in the bud too soon."
Calling the petition "an inherently and seriously flawed public policy
statement despite its good intention," the Portland guild of the Catholic
Medical Association has come out in opposition.
"Protecting the conscience rights of physicians and health care providers
is essential to any proposed constitutional amendment that seeks to
establish access to health care as a 'fundamental right,'" says a statement
from the guild's president, Dr. Lynne Bissonnette. "The conscience rights of
physicians and health care providers cannot be deferred for later inclusion
in statutory legislation."
Catholic social teaching has held up health care as a basic right flowing
from the dignity and sanctity of human life.
Last fall, Portland Archbishop John Vlazny called for universal coverage,
noting that workers are getting less and less insurance. The archbishop
pointed out that the U.S. Catholic bishops launched a campaign to extend
coverage to the uninsured. The bishops said any plan should meet four
criteria - respect for life, priority of the poor, universal access to
comprehensive benefits and inclusion of all sectors in healthcare, including
Church leaders fear some of the criteria don't register on the radar
screens of those backing the initiative.
In recent sessions of the Oregon Legislature, Robert Castagna, executive
director of the Oregon Catholic Conference, has sought conscience clauses in
other bills declaring a state policy on access to health care. The Oregon
Department of Human Services, supported by Senate passage of the legislation
sought by the department, offered "most strenuous opposition," Castagna
says. It turned out that the legislation died in the House, in large part
because of the missing conscience clause.
"If the state really wants more Oregonians to have health care, there is
no good reason to oppose a conscience clause," Castagna argues. "Unless,
that is, the state wants to impose its values on health care providers."
The issue of health care right of conscience is being debated across the
country. At least 18 states are considering new laws that protect health
workers who want to maintain their ethical rights of conscience.
Similar debates are under way in the European Union, where one panel has
advised that doctors should not always be allowed to refuse to do procedures
that counter their beliefs. That European committee made its decision after
extensive testimony from abortion-rights advocates.
In the Oregon petition, the phrase "fundamental right" caused the state's
Attorney General to figuratively raise his eyebrows. "Fundamental rights
are, relatively speaking, rare and few," he told state election officials in
a July letter on the petition's ballot title.
The wording also concerns Castagna, an attorney. He says the rare and
potent legal language could be in conflict with current rights.
"The initiative sets the fundamental right of access to health care
against the fundamental right of conscience of providers," Castagna says.
"Merely saying we will take care of this later is legally insufficient in
the face of a constitutional amendment."
The plan should also say where the money will come from, Castagna says,
fearing that other social services and education could suffer.
"A declaration of policy without the detail, without the plan, without
the funding mechanism and without a conscience clause is a fundamentally
flawed approach," he concludes.
The crux of the initiative petition is not unique to Oregon. The idea of
a state constitutional right to healthcare has faltered in Illinois,
Wisconsin, Vermont and North Carolina.
The Oregon petition is backed by local Democratic parties, several
unions, the Oregon Nurses Association and the Oregon Psychological
The Oregon Medical Association is not on the list of supporters. A
spokesman says the organization rarely takes a position on an initiative
before it qualifies for the ballot.
Providence Health System, which closely monitors proposed healthcare
legislation, has not yet decided what stance to take if the initiative makes
"We are always interested in measures that talk about increasing access,"
says Providence spokesman Gary Walker. "We have not decided to support,
oppose or stay neutral on this issue."
Chief petitioners say the Legislature "is letting us down" by not taking
up health care reform. They add that forcing lawmakers to craft a plan is a
good use of the initiative system.
"It could be a process where everyone could have their say in it,"
Greenlick says. "And remember we have never done anything in this state that
doesn't have a conscience clause."
Greenlick envisions a plan that would be able to snare more federal
healthcare dollars. As it is, Oregon leaves more than a billion dollars on
the table, in large part because it does not come up with matching dollars,
particularly for children's health.
The lawmaker also mentions an increased cigarette tax as a good
possibility for health revenue.
"We have a moral obligation to provide universal access to healthcare,"
says Greenlick. "To do this, it will have to be a matter of give and take."
Gilles MuÃ±oz has watched the number of uninsured outgrow the capacity of
safety-net clinics. Recent cuts by Congress threaten to make the problem
worse, he says.
Director of the Virginia Garcia Memorial Health Centers serving
Washington and Yamhill counties, MuÃ±oz has expanded services to include
about 25,000 patients. But that part of Oregon has an estimated 90,000
people without health coverage.
Forcing the Legislature to act via constitutional amendment will address
a crisis that has long been avoided, MuÃ±oz contends.
"It would be a mandate from the voters that this can't be ignored down in
Salem," he says.
MuÃ±oz is glad the initiative petition refrains from giving details. The
Legislature should craft a plan only after hearings and public input, he
A member of St. Andrew Parish, he wants any state health initiative to
have a conscience clause.
"I think there are going to be opportunities to deal with that in the
process of creating the plan," MuÃ±oz says. "Health providers who accept
Medicare and Medicaid are not required to provide every service. That could
be true of this, too."
In a prepared statement, Physicians for Compassionate Care said there is
too much at stake to leave the conscience debate for later.
"In a constitutional amendment establishing access to health care as a
'fundamental right,' the ethical rights of conscience cannot be ignored or
deferred for later statutory adoption," said the Portland-based group,
formed shortly after Oregon voters approved assisted suicide.