Legislature Protects Doctors Against Prescribing Birth Control, Emergency Contraception or Perform Abortions

Even under the most normal circumstances, it can be uncomfortable for a woman to talk about sex and contraception prevention with her doctor. Try to imagine what it must be like for a woman who has just been raped to have to drive herself to the hospital, undergo a painful pelvic exam, and then be told by the doctor that he will not prescribe the morning after pill for her even though she is requesting it. Why? The doctor says it is against his religious beliefs.

This is exactly what happened to Lori Boyer. Boyer, 35, and a man that she knew went to his home to hang out together. Instead, when they got inside the house, Boyer was assaulted by the man. He viciously threw her onto his bed and then told Boyer in a toneless manner afterward, "I'm done with you." Boyer grabbed her clothes and ran to her car. Even after this violent attack, Boyer possessed enough clarity to drive to the nearest emergency room and ask for a rape kit and to talk to a sexual assault counselor.

Boyer grimaced though a pelvic exam as she was bruised and in pain. As Boyer watched the doctor, Martin Gish, M.D., who examined her make some notations on a chart, she thought of some advice that the rape counselor had given her earlier.

"I need the morning after pill," Boyer told the doctor.

Dr. Gish, the trim, middle-aged man with slightly graying hair looked at Boyer in what she deems as an aloof manner and replied, "No," very abruptly. The doctor told her that he couldn't do that and then just went back to his writing.

Boyer could hardly believe what she was hearing especially after what she had just been through earlier that evening. She fought back tears as she pleaded with the doctor that she is mid-cycle and this puts her in danger of getting pregnant. Emergency contraception is most effective if administered within a short time frame, ideally 72 hours. If Dr. Gish wasn't willing to write an emergency contraception (EC) prescription then Boyer would gladly see a different doctor. Dr. Gish shook his head. According to Boyer, he said, "It's against my religion."

Boyer left the hospital empty-handed. "I was so vulnerable," she says. "I felt victimized all over again. First the rape, and then the doctor making me feel powerless."

It was later that day when Boyer's rape counselor found a physician for her who would prescribe the EC. Still, Boyer remained haunted over Dr. Gish's outright refusal. Boyer has been so distraught over the whole ordeal that she has not seen a gynecologist in the two and a half years since. "I haven't gotten the nerve up to go, for fear of being judged again," she says.

It is almost unimaginable that a doctor can refuse a woman's requests. However, that is exactly what is happening in medical offices and hospitals around the country. Catholic and conservative Christian health care providers are denying women standard, legal medical care.

Doctors from Planned Parenthood are reporting that patients are coming to them because other gynecologists refuse to prescribe birth control or give abortion referrals. Infertility clinics have refused unmarried women and lesbians. Some obstetricians and anesthesiologists are refusing to do sterilizations. Catholic hospitals have delayed doomed pregnancies because they believe abortions are only allowed when saving the life of the mother.

The New England Journal of Medicine published a survey this year reporting that 63% of physicians feel it is acceptable to tell a patient that they have moral objections to treatments and another 18% felt no obligation to refer a patient elsewhere.

Jamie D. Brooks, a former staff attorney for the National Health Law Program who still works on projects with the Los Angeles advocacy group says, "Doctors swear an oath to serve their patients. But instead, they are allowing their religious beliefs to compromise patient care. And too often, the victims of this practice are women."

The instances of pharmacists who refuse to dispense birth control and emergency contraception have been widely publicized while the physicians' refusals remain a more closeted topic. Why? The patients who are denied treatment rarely complain. The situation is extremely personal and patients who encounter these situations tend to feel humiliated. In the rare cases where patients do make noise about it, the cases are usually resolved quietly.

"The whole situation was traumatizing and embarrassing, and I just wanted to put it behind me," Boyer says.

Boyer only came forward after reading a story in her local newspaper that was almost identical to hers. Retail clerk, Tara Harnish, visited the same ER as Boyer after being sexually assaulted by a stranger and was examined by Dr. Gish. Dr. Gish also refused emergency contraception for Harnish. "Then I knew it wasn't just me, that this was a larger problem and it could happen to anybody," Boyer says.

Harnish, 21, was shocked at the way Dr. Gish treated her. "He seemed more concerned with saving the (potential) pregnancy than he was with my own health," she says. "He turned me away when I needed medical help. That is not what a doctor is supposed to do." Harnish and her mother contacted the local newspaper and despite the attention that the story received, Dr. Gish continues to work at Good Samaritan Hospital. The spokesman for the hospital, Bill Carpenter would only say that, "the issue has been resolved internally, and we're going to move forward."

In most cases, many women do not know when a doctor is withholding treatment. It is estimated that one in three women don't know about emergency contraception. According to the New England Journal of Medicine, 8% of physicians said they felt no obligation to present all options to their patients. Jill Morrison, senior counsel for health and reproductive rights at the National Women's Law Center in Washington, D.C. says, "When you see a doctor, you presume you are getting all of the information you need to make a decision. Especially in a crisis situation, like a rape, you often don't think to question your care. But unfortunately, now we can't even trust doctors to tell us what we need to know."

The American Medical Association in Chicago, the nation's largest physician group, adheres to the policy that a doctor can decline a procedure if it conflicts with his or her moral ideology. The law also favors the doctors' right to choose. Following Roe v. Wade in 1973, Congress passed the so-called Church Amendment, which allows federally funded health care providers to refuse to do abortions. 46 states have their own abortion refusal clauses, also called conscience clauses, allowing doctors to opt out. Man states are going even further. Sixteen legislatures are giving doctors the right to refuse to perform sterilizations. Eight states say doctors don't have to prescribe contraception.

When Elizabeth Dotts, 26, walked into her new doctor's office for a gynecological exam and checkup, she didn't know that she was about to cross the lines of a cultural war. "I was just going for my annual visit, nothing out of the ordinary," says Dotts, a YWCA grant coordinator. Dotts was single, had recently moved to Birmingham, Alabama, and decided to see an M.D. recommended to her by a coworker. The visit was unremarkable until Dotts asked for a refill of her birth control prescription. That is when the doctor told her that he does not prescribe birth control because he is Catholic and the pills are against his religion.

"The look he gave me actually made me feel ashamed," Dotts says. "Like I had this wild and crazy sex life. Like he was trying to protect me from myself." Dotts got angry. "I thought, 'Wait, what in the world? Where am I?'" Dotts quickly remembered that her insurance covers only one gynecological visit a year. Dotts majored in religion in college and got tough with the doctor.

"I'm glad to hear that you are faithful," she told him. "But I am here for my treatment and I expect you to give it to me." After five minutes of arguing, the doctor relented with a six month prescription, only after Dotts told him she had been put on the Pill to relieve menstrual cramping, not to prevent pregnancy. Dotts got her prescription and left. She vowed to find a new gynecologist. "Before, when I walked into a doctor's office, I assumed we were on the same side," she says. I do not make that assumption now. I ask a million questions and advocate for myself."

What we are facing in these situations is a limitation on women's health care. Reproductive health is being viewed as something other than regular health care. It is not being looked at as a straightforward matter of treating and healing, but rather something that is laden with morality. Since women's reproductive health is being looked at this way, it has become something that providers are able to say yes or no to. For the most part, men are able to escape this scrutiny. It is pretty difficult to imagine a man being made to feel as if he is going to hell because he chooses to take Viagra or get a vasectomy. If women come to fear going to the doctor, then a whole new set of problems will certainly develop. The women that fear judgment from the physician may not communicate effectively with their doctors, and even worse, may stop seeking treatment. Any way this situation is looked at, it is dangerous for women. Since the laws heavily favor the rights of the doctor to refuse treatment based on moral objections, women need to educate themselves about which physicians and hospitals may not prescribe birth control, emergency contraception or perform abortions so that they may avoid unnecessary trauma and judgment from a doctor. Women need to know that every Catholic hospital is bound by the ethical directives of the U.S. Conference of Catholic Bishops, which forbid abortion and sterilization (unless lifesaving), in vitro fertilization, surrogate motherhood, some prenatal genetic testing, all artificial forms of birth control and the use of condoms for HIV prevention. Baptist and Seventh Day Adventist hospitals may also restrict abortions. This means that if your local hospital is taken over, or if you are rushed to the nearest emergency room, you could be in for a surprise at the services that you can't get.