Doctors could refuse treatment on moral grounds under proposed Iowa bill

DES MOINES — Iowa Republican lawmakers advanced a bill on Wednesday that would allow health care providers, facilities and insurance companies to refuse medical care based on moral objections.

Under Senate Study Bill 3006, medical providers would have the right to not participate in any service that is contrary to their moral beliefs. Medical institutions — hospitals, clinics, pharmacies, or medical schools — also would be allowed to opt out of performing and paying for procedures that violate their conscience, and insurance companies would not be required to pay for services or medications that they have an objection of conscience to.

Providers and facilities still would have an obligation to provide emergency medical treatment to all patients.

Providers who refuse medical service based on conscientious objection would be shielded from liability for damages that arose from the objection.

Advocates of the bill, including conservative Iowa religious organizations, say it would protect doctors from being pressured to perform procedures they have a religious or moral objection to.

Tom Chapman, executive director of the Iowa Catholic Conference, said providers should have a right to exercise their conscience when dealing with patients. He pointed to existing protections for doctors who refuse to perform abortions and said the bill is an extension of that policy.

“No medical practitioner should be forced to participate in a procedure or medication to which he or she has an objection of conscience, or violate their oath to do no harm,” he said.

Opponents, though, said the bill could endanger patients and elevates the interest of providers over the health and needs of patients.

They said the effects would be particularly dire in Iowa, where rural populations face a severe lack of access to quality health care. Iowa is ranked among the worst states in the nation for access to maternal health care.

“I have not once seen a health care worker forced to do something they don’t want to do,” said Francesca Turner, an OB-GYN at Broadlawns Medical Center in Des Moines. “Pharmacists refusing prescriptions and doctors denying care, especially in rural Iowa, will only exacerbate the already dire health care crisis in our state.”

A growing number of states have adopted similar laws, sometimes called "medical refusal bills." Lawmakers in Florida and Montana both passed similar laws last year. Iowa lawmakers also have considered similar provisions in past years, but they have not been signed into law.

Mazie Stilwell, a lobbyist for Planned Parenthood Advocates of Iowa, said the proposed bill is “more extreme” than what has been put forward in the past and mirrors what other states have put in place.

“There is no original thought in this bill,” she told lawmakers on Wednesday. “What we have seen is that this is a culmination of all of these extreme provisions that we’ve seen shopped across the country all put into one bill.”

Protections from discrimination, First Amendment retaliation

Existing state law already allows doctors to refuse to perform abortions based on their religious belief or moral convictions. The bill would add to those protections and require providers to offer prior written consent before being asked to perform or assist in an abortion.

Medical institutions and practitioners would be protected from discrimination based on their refusal. Practitioners could not be denied privileges or public benefits based on their decision to opt out.

Providers would receive whistleblower protections from retaliations if they report a facility for violating the conscience objection law.

The bill also would protect doctors and other providers from being punished or having their license revoked by a state entity based on First Amendment protected speech, unless that speech directly harmed a patient.

Senator: Disagreements over 'do no harm'

The bill was advanced by a three-person Senate subcommittee on Wednesday. Republican Sens. Jason Schultz of Schleswig and Jeff Taylor of Sioux Center voted to advance the bill, while Democratic Sen. Janet Petersen of Des Moines voted against it.

Taylor said he had heard from medical students in past years who were concerned they would be pressured to perform procedures during their training they have a moral objection to. He invoked the Hippocratic oath and said the bill would protect providers who do not want to perform procedures they think would harm patients.

“The whole idea of, first, do no harm — We don’t always agree on what harm is,” he said. “Harm versus health, two medical professionals who have been well-educated and have lots of years of experience may see those in diametrically opposed ways.”

Petersen said she had not heard from any physician who said they had been pressured to perform a procedure against their moral beliefs. She said the bill would further strain health care for women.

“I think this bill is trying to fix something that is not broken,” she said. “I have yet to see a single example come forward. I also have an extreme level of concern about the number of bills that we continue to see going after Iowa’s access to health care.”

After passing the subcommittee, the bill is now eligible for a vote in the full Senate Judiciary Committee.