Emergency Medicine Archives - Protection of Conscience Project Library

Maryland’s conscience clause: leaving a woman’s right to a health care provider’s choice

Maria Cirincione

Extract
Conclusion
. . . Currently, ambiguities in the Maryland statute allow too much flexibility for providers in emergency rooms to refuse to provide or even inform patients about emergency contraception. This kind of state sanctioned refusal serves as the kind of government obstacle the Supreme Court has forbidden in upholding a woman’s right to bodily privacy. The Maryland legislature should act to eliminate the ambiguities in Maryland’s conscience legislation and explicitly protect a woman’s right to access emergency contraception in Maryland emergency rooms. In order to do so, the Maryland legislature should adopt the medical community’s definition for abortion that excludes emergency contraception. The new Maryland conscience statute should also provide explicit protections to patients receiving emergency room care. Physicians should be required to inform patients of emergency contraception if treatment in each particular case is medically indicated. Finally, physicians should be required to treat patients that request access to emergency contraception or to refer them to another provider who is willing to administer treatment within the effective time period of emergency contraception. . .

Cirincione M. Maryland’s conscience clause: leaving a woman’s right to a health care provider’s choice. J Health Care Law & Pol. 2010;13(1):171-202.

Emergency contraception provision: a survey of emergency department practitioners

Reza Keshavarz, Roland C Merchant, John McGreal

Abstract
Objectives: To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called “opt-out” or “abortion-related conscience clauses”) with those of practitioners from states without these laws.

Methods: Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed.

Results: The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with “abortion-related conscience clauses” and those from other states.

Conclusions: Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. “Abortion-related conscience clauses” did not seem to influence willingness to offer EC.

Keshavarz R, Merchant RC, McGreal J. Emergency contraception provision: a survey of emergency department practitioners. Acad Emerg Med. 2002 Jan;9(1):69-74.

Informed Consent for Emergency Contraception: Variability in Hospital Care of Rape Victims

Steven S Smugar, Bernadette J Spina, Jon F Merz

Abstract
There is growing concern that rape victims are not provided with emergency contraceptives in many hospital emergency rooms, particularly in Catholic hospitals. In a small pilot study, we examined policies and practices relating to providing information, prescriptions, and pregnancy prophylaxis in emergency rooms. We held structured telephone interviews with emergency department personnel in 5K large urban hospitals, including 28 Catholic hospitals from across the United States. Our results showed that some Catholic hospitals have policies that prohibit the discussion of emergency contraceptives with rape victims, and in some of these hospitals, a victim would learn about the treatment only by asking. Such policies and practices are contrary to Catholic teaching. More seriously, they undermine a victim’s right to information about her treatment options and jeopardize physicians’ fiduciary responsibility to act in their patients’ best interests. We suggest that institutions must reevaluate their restrictive policies. If they fail to do so, we believe that state legislation requirng hospitals to meet the standard of care for treatment of rape victims is appropriate.

Smugar SS, Bernadette J Spina BA, Jon F Merz JD. Informed Consent for Emergency Contraception: Variability in Hospital Care of Rape Victims. Am J Public Health. 2000 Sep;90(9):1372-1376.