By Linda Carroll

(Reuters Health) – The vast majority of U.S. states have passed laws blocking civil lawsuits that might result from a doctor refusing to perform an abortion or certain other medical procedures because of religious beliefs, a new study shows.

The national survey found that 46 states had laws protecting medical professionals and institutions from being sued for harm to patients related to a refusal to provide services out of conscience, researchers report in JAMA.

“The biggest takeaway from this research is that while people are aware that conscience laws may impact a woman’s right to access reproductive services, they may not know that these laws also may impact access to the legal system when they are injured as a result of conscientious refusal,” said the study’s author, Nadia Sawicki, Georgia Reithal Professor of Law at the Loyola University Chicago School of Law.

“The majority of patients have no idea whether their local hospital is religiously affiliated,” Sawicki said. “So they don’t know if there are providers who can’t provide services. I hope this research brings to light the very real impact that conscience laws have not just on access to care but also on the right to legal recovery in cases where the patient is injured.”

While the current report analyzed laws affecting abortion, Sawicki noted there is a larger study that looks at other reproductive services, including sterilization, emergency contraception and assisted reproduction. The full dataset is available on the LawAtlas Policy Surveillance Portal, Sawicki said.

To take a closer look at the prevalence of these conscience laws, Sawicki combed through Westlaw, the most widely used research database of state laws and regulations, and state legislative websites to identify laws in effect as of December 17, 2018, that protect the right to refuse participation in abortion. (Westlaw is a product of Thomson Reuters but is otherwise unrelated to Reuters Health.)

Altogether, 46 states had one or more laws protecting clinicians and institutions, as well as other individuals and entities, from adverse consequences that might arise as a result of their conscientious refusal to participate in abortion. The most common protection was a prohibition on civil lawsuits against conscientious refusers, Sawicki reported.

Most states did not have exceptions to the laws, even in cases of potentially fatal ectopic pregnancy, and most did not require the clinician to provide a referral or information regarding access to services. Twenty-six states imposed no conditions on the rights of refusal.

Some states did limit the immunity from lawsuits in cases of emergency (13 states), miscarriage (four states), and ectopic pregnancy (three states).

The study shows that the majority of states have given more weight to the providers’ rights than to the patients’ needs, said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. It’s “disturbing that patients in 37 states do not have a right to those services and that patients have been injured as a result,” Wu said. “It’s a widely held belief that the patients should come first.”

“This crosses a line to the point where employee rights are encroaching on patients’ rights,” Wu said. “I think patients need more safeguards to make sure their right to health is not trumped by the preferences of medical professionals.”

SOURCE: JAMA, online November 19, 2019.