We’re on a roll with guest posts here at Eclectablog this week. Today we have a terrific essay by Amy Lynn Smith, a Michigan-based writer and communications strategist who frequently covers healthcare, government and issue advocacy. She’s writing about Senate Bill 136, legislation that is touted as giving healthcare providers a right to decline to provide or pay for certain healthcare services that they find “objectionable”. As you’ll soon see, this bill is dangerous and there is far more to it than first meets the eye. Fortunately it has not yet passed in the Senate or the House so there is still time to contact your legislator and urge them to vote against this odious, discriminatory bill.

Amy comes to me highly recommended as a writer. In addition to her writing, she served as Deputy Digital Director for Obama for America-Michigan in 2012. You can read more from her at www.alswrite.com and you can find her on Twitter at @alswrite. Please welcome her to Eclectablog.

This bill is dangerous, deceptive and discriminatory.



[Photo by Anne C. Savage, special to Eclectablog]

The proponents of Michigan’s SB 136 will tell you it’s all about protecting religious and moral liberties. Here’s my question for them: Exactly whose rights are they protecting? They’re sure not protecting mine, or those of many Michigan citizens.

Titled the “Religious Liberty and Conscience Protection Act,” this bill would give healthcare providers, facilities and insurers the right to refuse to provide or cover “objectionable” healthcare services on religious or moral grounds.

But who exactly determines what’s considered “objectionable”? A doctor or nurse? A hospital system administrator? An insurance company? What about the patient and his or her family? If this bill were to become law, any of these entities could define “objectionable” … except for patients and families.

Eclectablog was one of the first to write about this version of the bill, and this post from last month does an excellent job of detailing the key provisions.

Having read the bill and the Senate’s nonpartisan bill analysis (pdf), what I find most troubling is that SB 136 extends broad protections to healthcare providers and related industries, while taking away the rights of patients and consumers.

The language of the bill is vague, opening the door for broad interpretation and discrimination.

Under SB 136, virtually anyone in the business of healthcare — including hospitals, private practices, universities and even pharmacies that provide healthcare services — could refuse to perform services based on a religious or moral objection.

But what exactly is a “moral objection”? If someone has a moral objection to smoking, will some doctors refuse to treat a smoker? Nothing in the bill says they can’t.

Obviously intended to placate providers and insurers who object to abortion (which providers already have the legal right not to perform), SB 136 goes many, many steps too far. It could be interpreted to allow providers and insurers who object to birth control to refuse to offer it to patients, even if there’s a medical need. It could permit providers to refuse treatment to someone with HIV/AIDS or even someone of a religion different from their own. There’s nothing in the bill that explicitly forbids any of that.

The only language in the bill that could protect against discrimination the clause that specifies that moral or religious objections can’t be invoked if “The objection is based on the patient’s or a group of patients’ status, or a patient’s insurance coverage, ability to pay, or method of payment.”

What exactly is a patient’s “status”? Health status? Lifestyle status? Religion? Race? Gender? Immigration status? That language allows too much leeway to offer any real protection to patients. The bill goes into great detail about the definition of terms such as “health facility” and “health care service,” but it never defines “status.”

SB 136 is chock-full of protections for healthcare providers, facilities and insurers. But there are scant protections for patients.

The bill requires healthcare facilities to honor the religious or moral objections of providers and insurers, and allows most healthcare facilities to make objections of their own. But, as a patient, you won’t know what services a provider or facility won’t offer. They are under no obligation to tell you unless you ask.

If you bring a loved one who is dying of cancer to a nursing home, you’d better ask first about their policies and caregiver objections. Even if you have legal documents requesting to be taken off life support, a caregiver can present a moral objection to providing that service on the spot.

So a patient can be kept alive against his or her wishes, but a caregiver’s objections must be honored. As someone who watched her father die painfully by inches, the idea that anyone could have had the power to prolong his agony is excruciating.

What’s more, you can’t take legal action against a facility or provider for harm caused by their refusal to provide service. SB 136 protects them against any legal challenges related to moral or religious objections.

When SB 136 was before the Senate Committee on Health Policy, state Senator Rebekah Warren offered three amendments to the bill. According to the Detroit Free Press, the amendments would have:

Required healthcare professionals and institutions to post notice if they wouldn’t provide services they object to

Forbidden the objection to be asserted if there were no other medical facilities available within a 25-mile radius

Required medical institutions and professionals to provide healthcare in emergency situations

On all three amendments, Sen. Warren was the sole “yes” vote. And with that, all efforts to protect and inform consumers were thwarted.

There is nothing in SB 136 that unequivocally overrules religious and moral objections in the case of an emergency.

Sen. Warren’s amendment requiring just such an exemption demonstrates how unclear the bill’s position is on this.

The bill states that a religion or moral objection can’t be invoked if:

“A patient’s condition, in the reasonable medical judgment of an attending physician, medical director, or registered nurse, requires immediate action to avoid permanent physical harm to the patient and no other qualified health provider is available to provide that health care service.”

But what if the attending physician is the one who has the moral or religious objection? That’s a clear conflict of interest. Who would protect the patient if this physician, for example, refused to perform an abortion that would save the life of the mother? What if this physician felt a religious or moral obligation to protect the fetus by not sharing the facts of the case with anyone else?

If you think this idea is far-fetched, consider the case of Savita Halappanavar, the woman in Ireland who died because doctors wouldn’t perform an abortion even though she was already having a miscarriage.

What’s more, the bill only addresses “permanent physical harm,” utterly ignoring the risk of emotional or psychological harm. A physician’s refusal to provide care to someone in unbearable pain, which Halappanavar reportedly was, could be terrifying enough to trigger post-traumatic stress disorder.

SB 136 violates the civil liberties of citizens and the U.S. Constitution.

For all the “protections” it would enshrine in Michigan law, SB 136 doesn’t protect the rights of patients to make their own care decisions. Nor does it consider the religious liberties of patients who may not share the beliefs of their doctor.

This bill scoffs at one of our country’s founding principles: the separation of church and state. The Michigan legislature shouldn’t be getting involved in religious issues. When you get right down to it, that is exactly what this bill is all about.

Freedom of religion and freedom from religion are fundamental rights in this country. Legislation that favors one set of beliefs over another violates those rights. This bill does that, too.

Here’s what I believe: Every citizen of Michigan deserves the right to medical care. They shouldn’t have to wonder if a doctor will provide the services they need — especially in an emergency. They should have the right to know if an insurer or provider will have moral or religious objections to any services they may need. Not having that information takes away a patient’s ability to give informed consent, which they must do before treatment is administered.

Ultimately, citizens should be entitled to live their lives as they choose. Those choices should never impact their ability to obtain health insurance or treatment.

This bill will come before the Michigan Senate for a vote. Please let your Senator know that SB 136 puts the rights — and quite possibly the lives — of Michiganders at risk.