Prepared
Witness Testimony
The Committee on Energy and Commerce
W.J. "Billy" Tauzin, Chairman
Protecting the Rights of Conscience of Health Care Providers and a Parent's Right to Know.
Subcommittee on Health
July 11, 2002
3:00 PM
2123 Rayburn House Office Building
Ms. Catherine Weiss
Directo
ACLU Reproductive Freedom Project
125 Broad Street, 18th Floor
New York, NY, 10004
Chairman
Bilirakis, Ranking Member Brown, and members of the Subcommittee:
My
name is Catherine Weiss and I am the Director of the American Civil Liberties
Union's Reproductive Freedom Project. I
am pleased to testify today on behalf of the ACLU about refusal clauses in the
reproductive health context. The ACLU is a nationwide, nonpartisan, nonprofit
organization of approximately 300,000 members dedicated to protecting the
principles of freedom and equality set forth in the Constitution and in our
nation's civil rights laws.
Today,
I will explain the practical impact of refusal clauses (sometimes also called
religious exemptions or "conscience clauses") that permit entities and
individuals to refuse to provide or cover health services to which they object
on religious or moral grounds. I
will provide a brief overview of federal refusal clauses. And I will offer an analytic framework for evaluating refusal
clauses that balances protection for religious liberty with protection for the
public health. Finally, I will
explain that the public overwhelmingly rejects the principles that underlie
overly broad refusal clauses, and I will urge you to oppose H.R. 4691 because
it would impose unacceptable burdens on women of all faiths and no faith
seeking reproductive health care in public, secular settings.
The
ACLU has a long, proud history of vigorously defending religious liberty.
In Congress and in the courts, we have supported legislation providing
stronger protection for religious exercise - even against neutral, generally
applicable laws. For nearly a decade, the ACLU fought to preserve or restore
the highest level of constitutional protection for claims of religious
exercise. We were founding
members of the coalition that supported the Religious Freedom Restoration Act
in 1993, and we were instrumental in urging Congress to enact the Religious
Land Use and Institutionalized Persons Act of 2000.
We have also represented persons challenging burdens on the exercise of
their religious beliefs. For
example, we have sued to protect the right of Jewish students to wear a Star
of David pendant at school; we have sued to defend the right of conservative
Christian activists to broadcast on public access television; and we have
filed a brief in support of two women who were fired for refusing to work at a
Greyhound racetrack on Christmas day. We
even offered to back the Rev. Jerry Falwell in his 2001 challenge to Virginia
laws restricting ownership of church property.
We
have been equally vigilant in our advocacy of reproductive rights.
The ACLU fought long and hard to persuade Congress to pass the Freedom
of Access to Clinic Entrances Act to protect reproductive health clinics,
patients, and professionals from deadly violence.
We are currently key supporters of the Equity in Prescription Insurance
and Contraceptive Coverage Act to ensure more widespread access to
contraception for working women. We
have participated in nearly every critical Supreme Court case protecting
reproductive freedom, from Roe v. Wade to Planned Parenthood v.
Casey to Stenberg v. Carhart.
This history makes the ACLU well-positioned to assist the Subcommittee
in its consideration of refusal clauses, which, as is illustrated below, can
have a dramatic effect on the health of women.
A
CASE IN POINT
In the
Spring of 1994, a nineteen-year-old Nebraska woman, Sophie Smith,[i]
was admitted to the emergency room at a religiously affiliated hospital with a
blood clot in her lung. Tests
revealed that Smith was approximately ten weeks pregnant, and that the
clotting problem resulted from a rare and life-threatening condition
exacerbated by the pregnancy. The
hospital immediately put Smith on intravenous blood-thinners to eliminate the
existing blood clot and to help prevent the formation of more clots that could
kill Smith instantly if they lodged in her lungs, heart, or brain.
Smith's
doctors told her that she had two alternatives.
She could stay in the hospital on intravenous blood-thinners for the
remaining six-and-a-half months of her pregnancy. She would also need a procedure in which doctors would insert
an umbrella-like device into one of her veins designed to catch blood clots
before they reached a vital organ. Or
she could have a first-trimester abortion, switch to oral blood thinners, and
be released from the hospital. Smith
decided to have the abortion. She
wanted to go home to care for her two-year-old child.
On the
morning Smith was scheduled to have the abortion, the hospital lawyer appeared
in the operating room. He
announced that the hospital would not permit an abortion on its premises -
even though four doctors had certified that an abortion was necessary to save
Smith's life. The lawyer was
armed with a state refusal law that stated, "No hospital, clinic,
institution, or other facility shall be . . . required to allow
the performance of an abortion therein."[ii]
The procedure was canceled and ten days of dangerous delay followed.
Smith
wanted to be transferred to a facility that would perform the abortion, but
moving her increased the risk that a blood clot would kill her. Because the blood-thinners she was taking made her prone to
excessive bleeding, Smith's doctors felt that she should be treated in a
hospital. But the hospital
refused to reconsider its decision not to allow the abortion on its premises.
Notwithstanding the risks to her health, Smith was ultimately
transferred by ambulance to her doctor's office.
He performed the abortion and sent her back to the hospital.
Smith
was lucky in the end. She
survived the risks she faced when this hospital refused to treat her.
But the risk itself was unacceptable.
A
BRIEF OVERVIEW OF FEDERAL REFUSAL CLAUSES
Refusal
clauses pertaining to certain reproductive health services swept the nation in
the years following the Supreme Court's 1973 decision legalizing abortion in
Roe v. Wade. Congress
started the trend that same year when it passed legislation (sponsored by
Senator Frank Church and known as the "Church Amendment") in reaction to a
1972 court order that had required a Catholic hospital to allow a
sterilization procedure to be performed on its premises.
The Church Amendment established that an individual's or entity's
receipt of federal funds under certain public health programs is not a basis
for requiring recipients with moral or religious objections to perform or
assist in sterilization or abortion procedures, or to make facilities or
personnel available for the performance of such procedures.
The legislation also prohibits certain federally funded institutions
from discriminating in employment, or in the extension of staff or other
privileges, against any health care professional because the professional
refuses to perform or assist in an abortion or sterilization procedure based
on a religious or moral objection; because the professional does perform or
assist in abortion or sterilization procedures in a separate setting; or
because of the professional's religious or moral beliefs concerning these
procedures.
In
1996, Congress adopted the Coats Amendment.[vii]
The amendment prohibits the government from "discriminating"
against medical residency programs or other entities that lose accreditation
because they fail to provide or require training in abortion services.
The amendment was passed after the Accreditation Council for Graduate
Medical Education adopted a professional standard requiring residency programs
in obstetrics and gynecology to provide abortion training.
Under the standard applicable at that time, residency programs or
physicians with religious or moral objections could opt out of the required
abortion training, although programs remained responsible for insuring that
willing residents received abortion training at another institution. The Coats Amendment established that the government could not
"discriminate" against a medical residency program solely on the basis of
the program's refusal to train new doctors in abortion practice or to refer
them elsewhere for such training, even when a residency program lost its
accreditation because of its failure to offer training.
In
1997, Congress adopted new statutory requirements for the Medicaid program
that, among other things, mandated that states inform patients about how to
obtain covered services - including family planning services - that their
Medicaid managed care organization did not provide.[viii]
Congress made clear, however, that the new provisions did not require a
Medicaid managed care organization to provide, reimburse, or cover any
counseling or referral service to which the organization objects on moral or
religious grounds.[ix]
In
1998, Congress passed a hard-fought provision that required health plans
participating in the Federal Employees Health Benefits Program ("FEHBP")
- which provides health insurance for federal employees - to cover
prescription contraceptive drugs and devices.[x]
Federal employees can generally choose from a wide variety of
participating plans. Congress
explicitly exempted from the requirement five religiously affiliated health
plans that were then FEHBP participants.
It also created an exemption for "any existing or future plan, if the
plan objects to such coverage on the basis of religious beliefs."
(In the years since, no additional plan has requested a religious
exemption.) And, in 1999, the
House voted against an amendment
offered by Representative Chris Smith that would have broadened the exemption
to plans that object to contraceptive coverage on the basis of "moral
beliefs."
STRIKING
THE RIGHT BALANCE
The
framework we propose below for analyzing refusal clauses balances protection
for the public health in general, reproductive health in particular, patient
autonomy, and gender equality with protection for individual religious belief
and institutional religious worship. We
reject the imposition of religious doctrines on those who do not share them,
especially at the expense of the public health. At the same time, we seek the maximum possible accommodation
of an individual's religious or conscientious objections, so long as
patients' rights are not compromised as a result.
We also seek to insulate pervasively sectarian institutions from having
to comply with laws that interfere with their religious practices.
To
strike the proper balance, policymakers and advocates must consider each
proposed refusal clause carefully, tailoring it to its context.
Concrete examples may be clearer than general principles: every rape
survivor ought to be offered emergency contraception to protect herself from
getting pregnant as a result of the assault, no matter where she is treated;
an administrative assistant working at a Catholic university should not have
to pay out-of-pocket for birth control pills because her employer believes
contraception is a sin; but a church should not have to purchase contraceptive
coverage for its ministers and other clerics; and a doctor, nurse, or
pharmacist who cannot in good conscience participate in abortions or
contraceptive services should be allowed to opt out, so long as the patient is
ensured safe, timely, and financially feasible alternative access to
treatment. The factors we
identify for evaluating refusal clauses should lead to these kinds of fair
results.
A
FRAMEWORK FOR ANALYZING REFUSAL CLAUSES
Constitutional
principles neither require nor forbid most refusal clauses.[xi]
Nevertheless, legal principles are useful in constructing a framework
for analyzing when an exemption is called for and what it should look like.
Based in part on our study of the case law, the ACLU has identified two
measures for evaluating refusal clauses.
We consider first whether granting an exemption would impose burdens on
people who do not share and should not bear the brunt of the objector's
religious beliefs. Exemptions
that impose little or no burden on others are more acceptable; exemptions that
impose substantial burdens are less so. By
"burdens," we mean to include obstacles to health care and other critical
personal interests, but we do not mean to include the mere exposure of third
parties to religious practices or the tax or other financial burdens that may
result from permitting certain exemptions.
We consider next whether the exemption protects the religious practices
of pervasively sectarian institutions or instead protects institutions
operating in the public sphere. Exemptions
that insulate core religious functions are more acceptable than those that
spill over into the secular world.
These
measures are not part of any currently accepted legal test.
But they reflect concerns that have been an undercurrent in many
relevant cases without necessarily determining the outcome of those cases.
Although each measure has independent importance, there is some overlap
between the two: the imposition of particular religious beliefs on those who
do not share them is less likely within a pervasively sectarian institution
performing religious functions than in a more secular setting.
Avoiding
Burdens on Others
In the
reproductive health context, the risk of imposition on those who do not share
the objector's beliefs is especially great when an employer, hospital,
health plan, pharmacy, or other corporate entity seeks an exemption.
The refusal of such institutions to abide by reproductive health
mandates directly affects employees, patients, enrollees, and customers of
diverse backgrounds and faiths. The law should not permit an institution's religious
strictures to interfere with the public's access to reproductive health
care.
The
courts have repeatedly shown themselves wary of the imposition of an
institution's religious beliefs on others.
In Catholic Charities v. Superior Court,
for example, the California Court of Appeal explained at length why the state
was justified in adopting a narrow refusal clause that permitted only
pervasively sectarian organizations - such as churches, religious orders,
and some parochial schools - to refuse to include contraceptive coverage in
health plans for their employees. A
broader exemption, granting a right to refuse to Catholic Charities and other
church-affiliated organizations that employ diverse workforces, would have
meant "imposing the employers' religious beliefs on employees who did not
share those beliefs." An
expansion of the refusal clause would also have "undermine[ed] the
anti-discrimination and public welfare goals of the prescription contraceptive
coverage statutes."
Another
court expressed similar concerns in St. Agnes Hospital v. Riddick.
There, a board that oversees graduate medical education had withdrawn
accreditation from a Catholic hospital's ob/gyn residency program because of
several deficiencies, including the hospital's refusal to provide or
otherwise allow its medical residents to obtain clinical training in
contraception, sterilization, or abortion procedures.
The hospital claimed that the withdrawal of its accreditation amounted
to religious discrimination. The
court rejected this claim, concluding that the state had more than sufficient
reason to insist on comprehensive medical education despite the hospital's
religious objection. These
reasons included the public's "overwhelmingly compelling interest in . . .
competently trained physicians" and the importance of preventing the
hospital from "impos[ing] its Catholic philosophy on its residents, many of
whom are not Catholic."
The
threat of imposition on others is significantly reduced when the law protects
individual - as opposed to institutional - decisions about whether to
provide certain health services. The
federal Church Amendment contains antidiscrimination provisions that shield
the conscientious decisions of doctors, nurses, and other practitioners.
These provisions serve as a useful model in that they protect both
those who refuse to participate in and those who provide abortion or
sterilization procedures.
Laws
that protect individual religious refusals offer important protections for
health care professionals but may compromise the rights of patients unless
adequate safeguards are included. There
should be limits even to an individual health care provider's right to
refuse. For example, whatever
their religious or moral scruples, health professionals should give complete
and accurate information and make appropriate referrals.
Both legal and ethical principles of informed consent require doctors
to tell patients about all treatment options, "including those [the doctor]
does not provide or favor, so long as they are supported by respectable
medical opinion." Doctors who
refuse to treat should also "refer the patient to a physician who does offer
or favor the alternative treatment."
Nor can a health care provider's religious or moral convictions ever
justify endangering a patient's safety.
Courts have been appropriately intolerant of lapses in medical
professionalism, even when they are religiously motivated.
For example, a federal appeals court held that a New Jersey hospital
was not liable for religious discrimination in firing a labor and delivery
nurse who twice refused on religious grounds to scrub for emergency
obstetrical procedures. She
refused, although in both cases the pregnant women's lives were threatened,
and the hospital claimed her refusal in the second case dangerously delayed
treatment for a hemorrhaging patient.
Insulating
the Religious Functions of Pervasively Sectarian Institutions
The
second measure we use to evaluate refusal clauses focuses on the nature of the
institution and activity exempted. Churches,
temples, mosques, seminaries, and other pervasively sectarian institutions
engaged in religious practices ought generally to be free of the requirements
of laws repugnant to their beliefs. Among
health care institutions, privately funded Christian Science sanatoria may
exemplify those that should qualify for a religious exemption.
Such sanatoria are staffed by Christian Science healers, and they
attend only to those seeking to be healed exclusively through prayer.
When,
however, religiously affiliated organizations move into secular pursuits -
such as providing medical care or social services to the public or running a
business - they should no longer be insulated from secular laws that apply to
these secular pursuits. In the
public world, they should play by public rules.
The vast majority of health care institutions - including those with
religious affiliations - serve the general public.
They employ a diverse workforce. And
they depend on government funds. A
recent study found that Medicare and Medicaid accounted for 46% of total
revenues to religiously affiliated hospitals in California in 1998, while
unrestricted contributions, including charitable donations from church members,
accounted for only .0015% (or $15 in every $10,000) of total revenues.
These institutions ought to abide by the same standards of care and
reproductive health mandates as apply to other health care institutions.
Again,
in deciding Free Exercise claims, the courts have recognized the importance of
distinguishing the religious from the secular context.
In refusing to allow employment discrimination claims by ministers and
other clerics against their churches, for example, the courts have concluded
that the state should not intrude into matters of church governance and
administration because a church's autonomy in these areas is central to its
religious mission.
The courts have also noted that the employees of churches and comparable
religious institutions may be assumed, "based on the religious nature of the
employment, [to] agree with or willingly defer their personal choices to the
religious tenets espoused by their employer." On
the other hand, the courts have acknowledged the appropriateness of preventing
entities engaged in secular endeavors from foisting their religious principles
on members of the general public.
WHERE
THE PUBLIC STANDS
The ACLU
recently conducted public opinion research - including focus groups and a
nationwide telephone survey - on religious objections to providing
reproductive health services. This
qualitative and quantitative research shows that Americans overwhelmingly oppose
laws that protect religious objectors at the expense of the patient's rights
and the public health.
The
public opposes refusal clauses that threaten access to health care.
-
89%
oppose "allowing insurance companies to refuse to pay for medical services
they object to on religious grounds."
-
88%
oppose "allowing pharmacies to refuse to fill prescriptions they object to
on religious grounds."
-
86%
oppose "allowing employers to refuse to provide their employees with
health insurance coverage for medical services the employer objects to on
religious grounds."
-
76%
oppose "allowing [hospitals] to refuse to provide medical services they
object to on religious grounds."
The
public's insistence on access reflects its view that religious refusals
jeopardize women's health and lives.
Seven in ten Americans are concerned, for example, that if "religiously
affiliated hospitals are allowed to limit access to medical services, the health
and lives of many women will be threatened."
The
public believes that individuals must be allowed to make health care decisions
for themselves. While
proponents of refusal clauses often cast the issue as one in which religious
liberty is pitted against reproductive rights, the public sees this dichotomy asfalse.
-
72%
agree with the following statement: "Religious liberty is not threatened
by requiring hospitals to provide basic medical care.
We are not talking about limiting a person's ability to worship,
but access to basic health care."
-
Even
when the issue is presented as a choice between the religious interests of
institutions and the health care decisions of individuals, however, the
public backs the patient.
-
79%
believe that it is "more important to respect the personal conscience of
individuals making difficult health care decisions" than to "respect the
conscience of a religious hospital."
-
69%
believe that it is "more important to protect the reproductive freedom of
women" than to "protect the religious freedom of religious hospitals."
Moreover,
the public believes that the government's first responsibility is to
protect the public health.
-
72%
are more concerned that the government hold "all hospitals - whether
religiously affiliated or not - to the same standards" than they are
about keeping "the government from forcing religious hospitals to
violate their beliefs."
-
83%
believe that "if a hospital receives government funds, it should be
required to provide basic, legal medical services, regardless of the
hospital's religious objections."
Overall,
our public opinion research shows that Americans are deeply troubled by the
idea that religious interests could come between them and their health care
needs.
H.R.
4691 - A BROAD AND DANGEROUS REFUSAL CLAUSE
Based
on the framework outlined above, the ACLU opposes H.R. 4691, a bill sponsored
by Chairman Michael Bilirakis (R-FL), Majority Leader Dick Armey (R-TX), and
Representative Joseph Pitts (R-PA). H.R.
4691 would allow a broad range of health care entities to refuse to comply
with a wide array of federal, state, and local requirements to provide
reproductive health services. As
noted above, the United States Constitution does not require any exemption -
let alone such a broad exemption - from compliance with public health laws.
Moreover, H.R. 4691 fails the test set forth in the ACLU's framework
because its burdens would fall primarily on those who do not share the beliefs
that motivate the refusal and because it protects institutions engaged in the
public and secular provision of health care.
H.R.
4691 would build upon the Coats Amendment, an existing federal refusal clause
described above. If enacted, the
newly expanded language would provide (amendments in italics):
The
Federal Government, and any State or local government that receives Federal
financial assistance, may not subject any health care entity to discrimination
on the basis that -
(1)
the entity refuses to undergo training in the performance of induced
abortions, to require or provide such training, to perform, provide
coverage of, or pay for induced abortions, or to provide referrals for
such training or such abortions; . .
.
(c)
Definitions:
For
purposes of this section:. .
.
(2)
The term ''health care entity'' includes an individual physician or
other health professional, a postgraduate physician training program, a
participant in a program of training in the health professions, a hospital, a
provider sponsored organization, a health maintenance organization, a health
insurance plan or any other kind of health care facility, organization or plan.
Practical
Effects of the Proposal
The
main effect of H.R. 4691 is to prohibit a governmental entity from
"discriminating" - that is, treating a health care entity differently
- on the basis of the entity's refusal to perform, refer, train, cover, or
pay for abortions. But what
constitutes "discrimination" would no doubt be the subject of debate and
potential litigation.
H.R.
4691 could have the following effects, among others:
-
It would
compromise the ability of Title X clients to obtain information critical
to their health. Title X,
which provides federal funds for contraceptive services for low-income
individuals, requires that grantees provide a referral to a qualified
abortion provider upon request as part of non-directive options counseling
for pregnant women. H.R. 4691
would prohibit the federal government from enforcing this regulation if it
were deemed "discriminatory" to deny Title X grants to providers that
refuse to make abortion referrals. The
bill could thus undermine federal standards and compromise the health of
low-income pregnant women by denying them critical information.
-
It would
interfere with the delivery of abortion services to poor women in dire
emergencies.
H.R. 4691 would impede a state's ability to comply with the
federal Hyde Amendment, which mandates coverage of abortions for women in
the Medicaid program in cases of rape, incest, or where the pregnancy
endangers a woman's life. Requiring
Medicaid managed care organizations that participate in the program to
provide such coverage could constitute "discrimination" against those
that refuse to provide or refer patients elsewhere for these services.
-
It would
interfere with states' ability to enforce their own laws on abortion.
H.R. 4691 could prevent those states that cover medically necessary
abortions beyond those mandated by the Hyde Amendment (whether as a result
of state constitutional rulings or by virtue of state laws) from
effectuating that coverage by contracting only with Medicaid managed care
organizations that agree to provide or refer for abortion services. Currently, more than fifteen states require such
coverage. H.R. 4691 would
interfere with these states' ability to enforce their own laws and
constitutional decisions and to manage and ensure delivery of mandated
services within their own Medicaid programs.
-
It would disrupt
the enforcement of state health care regulations.
H.R. 4691 would thwart the enforcement of state and local laws that
require entities certified or licensed by the state to address the full
range of health care needs in the communities they serve.
A state might be prevented, for example, from denying a
"certificate of need" (a state-issued document that is similar to a
permit and that is often required before two hospitals can merge) to a
newly merged hospital that refused to provide even lifesaving abortions
and thus left pregnant women in the community without help in medical
emergencies. (Mergers between
a religiously affiliated hospital and a secular hospital often raise this
issue because some religiously affiliated hospitals insist that the newly
merged entity apply religious doctrine in the provision of health
services.)
-
It could immunize
a health care entity's refusal to provide emergency contraception, even
to victims of rape. Because it does not define the term "abortion," H.R.
4691 could permit health care entities to refuse to provide emergency
contraception, even to victims of rape.
Although emergency contraception is merely a high dose of ordinary
birth control pills and does not interrupt an established pregnancy, some
religiously affiliated providers define emergency contraception as an "abortifacient."
Health care entities that subscribe to this view could use this
bill to attempt to shield themselves from repercussions for refusing to
comply with state laws that require hospitals to provide emergency
contraception (or referrals for emergency contraception) to rape survivors
who present in their emergency rooms.
CONCLUSION
Even
interpreting it conservatively, H.R. 4691 is a potentially sweeping federal
exemption from current legal and regulatory requirements that govern access to
health services. In fact, it
amounts to a broad non-compliance permit for religiously affiliated entities
that serve the general public and receive public funds, but nevertheless want
exemptions from the general laws that govern other health care entities.
The ACLU therefore opposes this dangerous measure and respectfully
urges this Subcommittee to reject it.
ENDNOTES
[i].
Ms. Smith's name
has been changed to protect her identity.
[ii].
Neb. Rev. Stat. §
28-237.
.
See Taylor v. St. Vincent's Hosp., 523 F.2d 75, 76 (9th Cir.
1975).
.
Id. § 300a-7(c), (d), (e).
[viii].
42 U.S.C § 1396u-2(a)(5)(D).
[ix].
42 U.S.C § 1396u-2(b)(3).
[x]. Omnibus Consolidated and Emergency Supplemental Appropriations Act,
Pub. L. No. 105-277, § 656, 112 Stat. 2681 (1998).
[xi]. Employment Div. v. Smith, 494 U.S. 872 (1990) (holding that
the Free Exercise Clause does not entitle religious objectors to exemptions
from neutral, generally applicable laws); Corp. of the Presiding Bishop
v. Amos, 483 U.S. 327 (1987) (holding that the Establishment Clause does
not prohibit an exemption from Title VII of the Civil Rights Act that
permits religious organizations to discriminate on the basis of religion in
employment decisions.).
.
109 Cal. Rptr. 2d 176 (Ct. App.), petition for review granted,
31 P.3d 1271 (Cal. 2001).
.
748 F. Supp. 319 (D. Md. 1990).
.
Id. at 330. The
Accreditation Council for Graduate Medical Education (ACGME) has since made
clear that ob/gyn residency programs must offer clinical training in
contraception and sterilization. In
addition, the current standards require clinical training in abortion,
unless a residency program has a "religious, moral, or legal
restriction," in which case the program must nevertheless (1) ensure that
residents receive training in how to manage abortion complications; (2)
permit residents to receive abortion training elsewhere; and (3) publicize
the restriction to all residency applicants.
Program Requirements for
Residency Education in Obstetrics & Gynecology § V.A.2.d., e. (ACGME,
effective Sept. 1999), http://www.acgme.org/req/220pr999.asp.
As discussed above, however, the Coats Amendment requires that
residency programs be treated as accredited - for licensing, funding, and
other governmental purposes - notwithstanding any refusal to offer, refer
for, or arrange for abortion training.
42 U.S.C. § 238n.
.
42 U.S.C. § 300a-7(c), (d), (e).
.
President's Commission for
the Study of Ethical Problems in Medicine and Biomedical and Behavioral
Research, Making Health Care Decisions: A Report on the Ethical and Legal
Implications of Informed Consent in the Patient-Practitioner Relationship
76 (1982); see also Principles
of Medical Ethics of the American Medical Association, Policy E-8.08
Informed Consent (issued 1981), available at http:// www.ama-assn.org
(using policy finder); American
College of Obstetricians & Gynecologists Committee Opinion No. 108,
Ethical Dimensions of Informed Consent 7-8 (1992).
.
Shelton v. Univ. of Med. & Dentistry, 223 F.3d 220 (3d
Cir. 2000).
.
Lois Uttley & Ronnie
Pawelko, MergerWatch Project, Educ. Fund of Family Planning Advocates of
N.Y.S., No Strings Attached: Public Funding of Religiously-Sponsored
Hospitals in the United States 15 (2002).
.
See, e.g., Gellington v. Christian Methodist Episcopal
Church, 203 F.3d 1299 (11th Cir. 2000).
.
Catholic Charities, 109 Cal. Rptr. 2d at 189.
.
Riddick, 748 F. Supp. at 330; Catholic Charities, 109
Cal. Rptr. 2d at 189.
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Committee on Energy and Commerce
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