It is not common for legislation in Michigan to attract much
attention. However, the recent action on Michigan Senate Bill
972, and associated legislation, have generated several news
items and blog posts around the country. Because this is
something that affects me personally, and because the Legislation is so
obviously flawed -- in addition to having a bizarre twist at the end, I
have surveyed the various points made by the denizens of the
Blogosphere. Here is the preamble for
Senate Bill 972
A bill to provide standards for
personnel policies to protect the right
of conscience of health care providers who conscientiously object to
providing or participating in certain health care services under
certain circumstances; to provide for protection from certain
liability; and to provide for penalties and remedies.
The legal website Yclipse
to the four related bills:
protects any individual health care provider, such as a pharmacist,
nurse, or doctor, from being fired or disciplined over refusal to
perform acts, such as participating in an abortion or filling a
prescription for an abortion drug.
Two other bills, HB
5277 and HB
"would allow insurance companies to likewise exempt themselves from
medical practices they find morally objectionable." HB 5277 covers
"health care corporations", and HB 5278 covers insurers and HMOs. The
operative language in each is:
Notwithstanding any other provision of law, [an entity] may
refuse to offer or provide a health care benefit that violates an
ethical, moral, or religious principle reflected in its articles of
incorporation, bylaws, or an adopted mission statement.
For the duration of this article, I will refer to the entire package of
bills as "the Legislation." The current status and text of the
Senate bill can be found here
the House bill status is here
Notice that the State of
Michigan website also provides a link to a Legislative Analysis:
HFA - Legislative Analysis
The date, 3-222-04, indicates that it was one very long
congressional session. I'm glad I didn't have to sit through the
entire thing. I thought the Chicago White Sox & Milwaukee
Brewers baseball game at Comiskey Park, 05-09-1984, was long.
That game went for 25 innings. Having to add 191 days to the
month, just to finish a piece of legislation, must have been
Loose tangents aside, this is a serious matter; not only because of
what the Legislation itself does, but also because it indicates how
susceptible the Michigan Congress is to ideological influence.
An AP news article explaining the Legislation is here
Michigan House backs
conscience rights for health-care workers
By The Associated Press
LANSING, Mich. — The state House
has voted to protect health-care workers and insurers from being fired
or sued for refusing to perform a procedure, fill a prescription or
cover treatment for something they object to for moral, ethical or
The measures would apply to
doctors or nurses who decline to perform or assist with abortions and
to pharmacists who refuse to fill prescriptions for morning-after pills.
The Republican-controlled House
overwhelmingly approved the four-bill package as dozens of Catholics
looked on from the balcony.
The Michigan Catholic Conference,
which pushed for the bills, hosted a legislative day for Catholics
yesterday at the state Capitol. The Catholic Church opposes abortion
and birth control. [...]
, a website with
gay-oriented articles, reprinted
the AP story, using the headline, Michigan
Preparing To Let Doctors Refuse To Treat Gays. 365Gay.com added
editorial content to their reporting on the Legislation:
Michigan Bill That Could Deny Gays Health Care
23, 2004 5:32 p.m. ET
Michigan) Some Michigan legislators are calling for amendments to
a bill passed in the state House this week that could allow doctors and
nurses who object to homosexuality to deny gays treatment or
first by 365Gay.com, the Conscientious Objector Policy Act would allow
health care providers to assert their objection within 24 hours of when
they receive notice of a patient or procedure with which they don't
agree. However, it would prohibit emergency treatment to be refused.
The bill was
aimed at allowing doctors opposed to abortion or stem cell research to
refuse the procedures, but opponents of the legislation say it is so
loosely worded it could be used to refuse treatment to
in the legislature Rep. Chris Kolb (D-Ann Arbor) the first openly gay
legislator in Michigan, pointed out that while the legislation
prohibits racial discrimination by health care providers, it doesn't
ban discrimination based on a person's sexual orientation. [...]
I doubt that the bill was intended, originally, to have anything
to do with the civil rights of homosexuals. But since Rep. Kolb
raised the issue during debate, and it was not addressed, it does give
the appearance that the Michigan Congress is not concerned about this
aspect. Either that, or they are concerned, but only insofar as
it affects their re-election prospects.
Not all reporting was critical of the Legislation. LifeSite.com
, which presumably is a
pro-life/anti-abortion site, has the following report
Thursday April 22, 2004
Votes in Favor of Conscience Clause
Law would also protect pharmacists
LANSING, April 22, 2004
(LifeSiteNews.com) - The state House has voted to introduce conscience
legislation to protect medical professionals from being fired or sued
for failing to participate in procedures they are morally opposed to.
The Conscientious Objector Policy Act allows for a period of 24 hours
from the time a worker receives notice of a request to perform a
procedure in which to object.
The law not only applies to
health-care workers such as doctors and nurses, but also to pharmacists
who will now be protected from reprisals for not filling prescriptions
that conflict with their moral and religious beliefs. Pharmacists will
not be exempted from filling prescriptions for the birth control pill,
The sponsor of the primary bill, Republican Rep. Randy Richardville, in
response to criticism from Democratic representatives that the bill
would restrict patients' rights, said "Nothing in this bill, not a
thing, denies a patient from receiving medical care. This simply means
a medical professional cannot violate their religious obligations."
Rep. Richardville uses unfortunate wording here, "Nothing in this bill, not a
thing, denies a patient from receiving medical care. This simply means
a medical professional cannot violate their religious
The Legislation does not say that a
professional cannot violate her or his religious obligations; rather,
it says that a professional may choose to follow his or her religious
conviction without fear of certain kinds of reprisal. The other
part of what he said simply is not accurate. It leads me to
wonder if he thought through the implications of the Legislation.
There are some areas where there are either very few physicians, or
they all have the same religious convictions. In such an area, a
patient could very well be in the position of having care
denied. This is a serious problem with the
legislation. Many insurance plans provide a limitation on what
doctors a person can see, or limit the geographic area in which care
can be sought. (There are exceptions for emergency care out of
area.) It is likely that there will be situations in which a
patient does not have a realistic option available, because of these
kinds of limitations.
What about blogger commentary, which always is more interesting?
The popular medical blog, Medpundit
has a slightly positive take
on the Legislation:
gay person isn't a procedure or a service, he's a patient. That
doesn't mean the doctor can refuse to treat a homosexual for heart
disease, or an infection. It does mean that the doctor could refuse to,
say, sign off on an adoption physical for a homosexual patient, or
refuse to perform artificial insemination for a lesbian or a single
mother. Is that discrimination? Maybe. But it's not nearly the blanket
rejection of homosexuals that the first story made it seem.
To place this excerpt in context, Dr. Sydney Smith was comparing the
text of two news articles on the subject. To place it in a larger
context, note that the American Medical Association Code of Medical Ethics
(section E 2.05) contains this statement:
the case of single women or women who are part of a homosexual couple,
it is not unethical to provide artificial insemination as a
The AMA did not state explicitly that it would be unethical
to refuse to
provide this service to homosexuals. I don't know what their
silence means. Perhaps they assume that they do not need to
specify that such a refusal would be unethical. My guess is that
their committee did not want to go so far.
(note: you can download the entire AMA Policy, including the Code of Medical Ethics, from the
AMA website. This
is the link; it is over 8Mb. You have to agree to their
disclaimer before you can download it.)
Andrew Sullivan comes out with a criticism
of the Legislation:
CONSERVATISM: A Catholic and Republican initiative in Michigan will
allow doctors to refuse treatment to any person of whom they morally
disapprove. I can see why some doctors should be allowed to refuse to
perform abortions on moral grounds (except I doubt that any doctors are
routinely put in that position). But the sweeping nature of this bill
is clearly aimed at allowing doctors to refuse care to homosexuals
(there is an exception barring refusal of care on racial grounds). [...]
I have yet to read a conservative denunciation of this. Just as I have
yet to see this president do anything to distance himself from the
hatred coming from some parts of his own party. Why should it always be
up to gay people to point this out? Are there no straight people
prepared to stand up against this kind of thing in the G.O.P.?
I can't agree that it "is
clearly aimed at allowing doctors to refuse care to homosexuals"
However, I have no doubt that this will be the effect in some
situations. Yclipse casts a shadow
on Mr. Sullivan's point.
proposed law protects a person who objects to providing a health care service that is objectionable. It mentions
nothing about a patient who is objectionable to the provider.
This is true, but in practical terms, it is irrelevant. If a
physician refuses to do artificial insemination for a lesbian, citing a
moral objection, is it clear that the law not apply? If a
physician does refuse, will the patient have the legal resources to go
to court and fight it out? The point is that the Legislation
imposes a barrier to health care. Even if the the patient would
eventually win a challenge in court, there still is a barrier.
Atrios at Eschaton chimes
, adding a rather brazen title: The Taliban in America.
After quoting the news article, he concludes:
this law passes, I will personally help compile the wall of shame so we
can frequently and loudly object to anyone who thinks they have the
moral right to do this.
has the following
is not about religious freedom. This is about bigotry, pure and simple.
This is the modern equivalent of the laws that prevent people form
selling their homes to Jews in the first half of the twentieth century.
This is vile and disgusting, and it is supported by the Michigan
Republican Party -- the party of hate once again, it appears. And the
Catholics who supported this disgusting measure of hate should be
ashamed of themselves. Denying care to the sick and the dying is the
least Catholic thing I can think of.
One of the comments on Lean Left, by
Michigan Catholic Conference pushed for this? If the Pope doesn't
immediately put Michigan under an interdict until they shitcan this
measure, there's no justice on Earth. Damn, I'm so proud I left
the Church. This is disgusting.
The Dutch weblog, SILT, adds a bit more vitriol
Prodded by the Catholic Church,
the Michigan House has passed a law that would permit health-care
providers to refuse to provide services to homosexuals.
And so Christo-Fascism marches
Lara, at The Diary of Elle Wiz
has a strongly worded entry
is insane. This cannot possibly be constitutional. Someone please
offers a more
moderate, but still negative, view
of the Legislation:
real disturbing part is where the bill states that health care
workers can refuse service to anyone on moral, ethical or religious
grounds. In short - they don't have to service anyone they don't like.
Wouldn't that be weird if other jobs out there allowed you to do the
same - such as McDonalds - where you only served the people you liked
at the drive through window...
Doug, at George W. Bush, Will You
Please Go Now?!
the entire State because of the Legislation:
Michigan: You've just made me proud that I live in Alabama. On the
other hand, I'm not especially proud to be Catholic right now:
James, at jameswagner.com
does not come down so hard on Michigan as he does on the Catholic
Church. Excerpt from his post
it's 2004! Why do we still have to deal with this accursed thing? I've
absolutely had it with the abominations of the Catholic Church, and
don't get me started on all the other monstrously evil cults which
compete with it in advancing fear and superstition in this benighted
land and around the world.
[...] If these idiots want
religious war, I think we should let them have it. I'm in.
Sam, at mad LIFE
, seems rather upset
by the whole thing:
tired of all the bullshit. It's exhausting. I don't have the will to
even talk about much of it anymore - you may have noticed my lack of
blog entries with any substantial information, esp. anything about
politics. The truth of the matter is that I am quickly losing hope. One
day, I began to entertain the idea that I might hate America, just a
little, little bit. And every day, I think I start to hate it just a
little bit more (by "America," I mean a lot of stupid people)
[...] God bless the USA,
where freedom rings so loud that the majority & the rich can do whatever they want.
On the blog King of Zembla
In Other News, Jesus
Via Atrios. I haven't seen the
actual language of the bill, but if the description below is accurate,
wouldn't it allow a doctor to withhold treatment from Catholics?
[...] Our esteemed
colleagues at Musing's Musings report that Colorado is just as bad.
Is there a national movement afoot to deny medical care to minorities
that happen to be out of favor with the Republican party? And what was
the last country to adopt a national eugenics policy?
Was it by any chance the one my
old man went to war against?
A thoughtful and moderate opinion is snarled
by Robin at Giant Grizzly Twists And
. This resonates with my concern about the Michigan
Congress being susceptible to ideological influence:
part of a special "you ask for it we'll give it to you" legislative
day for Catholics, the state of Michigan has just passed legislation
that will allow any Doctor or health care worked the right to refuse to
treat anyone on the grounds of moral, ethical or religious grounds.
They cannot be sued. They cannot be disciplined. You cannot complain,
but you can die.
There something deeply offensive
about a religious organization controlling a state's legislative
in such a country as America where people are allowed to have religious
I am truly shocked that such a
Bill can be passed in America.
At A Man with a Ph.D. - Richard
, we find the following thesis
how is someone supposed to 'know' someone is gay, or a Catholic, or
living with someone. Those are all questions that are not allowed to be
asked before providing health. Will your ability to get healthcare
depend on gossip and innuendo, then? It is scary to believe that my
ability to receive medical care will be solely determined by the moral,
ethical and religious views of the health care workers, not on my need.
It must be nice to be allowed to enter an industry where you can opt
out of a procedure simply by saying doing so would violate my sincere
belief that disease is a curse from God, who will be the one to cure
A sarcastic but pointed version was floated on Push Fluids
, a blog by three
medical students. I post the entire thing
partly for comic relief. Medical students tend to have a strange
sense of humor.
manual disimpaction count as morally repugnant?
Dr. Quinn and I
were apparently working in fits of righteous anger at the same time...
Here's a link to
the bill passed the Republican-controlled house yesterday that she was
talking about. The "Conscientious
Objector Policy Act," would provide legal cover for a healthcare
provider to refuse to treat a person, or perform a procedure, or prescribe
a goddamn drug if it ran counter to their religious, ethical, or
Awesome. So now
all I have to do is graduate from medical school, do
a quick residency, and then get a job at Planned Parenthood in Flint,
MI. Then I can bust out with some newly found Catholic religious fervor
and refuse to ever show up to work because it's an abomination before
god. Those godless bastards won't have a legal leg to stand on when
they try and can me! Yep. I'll be having fun in the legal protection of
the Son (of man). (Sorry, I couldn't resist that last one. Yes, I know
it's not even funny.)
related news, California is working on passing a bill that
protects clergy from being fired for refusing to preach the word of God
or provide their congregations with those little Jesus crisps.
On a more serious note, also on Push
Fluids, but by a different blogger, the following
would argue that allowing physicians to refuse treatment of people who
they would feel uncomfortable treating is better for the patients. but
these people are wrong.
first, in a state like michigan,
where there is a bible belt that is quite rural, there is a great
possibility that gay people would have to travel long distances to find
a physician willing to treat them. in addition, there is a greater risk
to homosexuals who are in emergency situations. it is quite possible
that this law could allow ER docs, and EMTs to refuse to treat someone
who is homosexual in an emergency situation.
this is not an unheard of
phenomenon. a woman named tyra hunter died in washington dc after a car
accident. as she lay on the street, an EMT stopped treating her when he
found that she had male genitals. robert eads was a female to male
transsexual who died of ovarian cancer in georgia because he could not
find an ob/gyn willing to take care of a transgender patient (there was
an excellent HBO documentary about him). there are countless others
(brandon teena, matthew shepard, etc.) who have died because people
refused to help or protect them and allowed hatred and prejudice rule
i just don't know what to say
about this. i'm tired. i'm just beside myself that there are people in
this world so hateful.
Paul, at A Fortiori
even more anti-Michigan sniping
Michigan is now officially off the list of "States I Might End Up
A Livejournal site, Feminist Rage, contains emotional -- but considered
and nuanced -- commentary. Here is a piece by Wiilowbean and a
comment by ggdsbuckeye:
doctors and nurses can refuse to give out or even talk about EC or
birth control even if you ask for it. Pharmacists can refuse to fill
birth control prescriptions. And my personal favorite, any health care
provider can refuse to treat you if they believe you're gay. Because
god forbid those horrid homos have access to medical care.
I can't even begin to process how outraged this makes me. Lesbians
already have lower rates of seeking health care especially for things
that can make a huge difference in health like annual paps. There's
already enough bigotry and just plain old ignorance in the medical
community about queers that creates barriers to care and now they want
to go and make that not only legal (because since there's no
anti-discrimination laws it already is) but legislatively encouraged.
[...] Furthermore, this bill does not
contain any provision for referring the patient for requested services.
Feminist Rage is referring to emergency contraception with the acronym
EC. She is not quite right about the birth control. The
Legislation includes the following language:
care service does not include the provision of a contraceptive
At first glance, this would appear to mean that neither birth control
nor EC would be affected by the Legislation. However, there is a
medication" means a medication approved for the prevention of pregnancy
that is taken or used in advance of sexual intercourse.
This specifically excludes EC, since EC is given after
Those that wish to argue that the Legislation is not ideologically
influenced will have to explain the existence of this specific
wording. Most health care providers, and probably most randomly
selected citizens, would not define "contraceptive medication" in this
The last quoted line from Feminist Rage has to do with referral for
services. It is, presumably, a reference to the section that
defines "participation" in a health care service:
or "participating" means, at a minimum, to counsel, refer, perform,
administer, prescribe, dispense, treat, withhold, withdraw, diagnose,
test, evaluate, train, research, prepare, or provide material or
physical assistance in a health care services. .
This means that a health care provider (or other person, such as a
representative of a hospital or insurance company) could refuse to tell
someone whether or not the requested service is available elsewhere, or
even refuse to discuss it at all. Personally, I find that highly
offensive. This would mean that a person could call her or his
insurance company and ask about the coverage for a particular service,
and the company person could refuse to discuss it.
From The Republic of T
Terrence is teed off, as we see from these comments
my question for the Michigan Catholics who supported this
bill. Was there anyone that Jesus refused to heal? Whom did he turn
For once, I am
completely, and utterly speechless. This is just
another example of how compassionate conservatism is a crock of shit.
Update: Apparently, the law bars health
care providers from refusing service to those who belong to protected
classes under Michigan law. Gays, however, are not protected from discrimination under
Michigan law. So under this law, gays can be denied services by health care
providers who morally object to homosexuality.
I cannot say whether Michigan law contains no provision for protection
of civil rights of gay or lesbian persons. I can, however, say
that the Legislation does not:
health care provider shall not assert an objection to providing or
participating in a health care service based on the classification of a
patient or group of patients protected under the Elliot-Larsen civil
rights act, 1976 PA 453, MCL 37.2101 to 37.2804, or based on a disease
or other medical condition.
The text that defines groups covered by the Elliot-Larsen civil rights
act can be found here
It does not offer any protection to homosexuals.
Kriston at Grammar.police writes a ticket
for the Legislation:
[...] The site
from which Atrios clipped focuses on the effect on the gay community,
but remember that Catholics hate all sorts of people. I'd like to
believe that anyone who's taken the Hippocratic Oath couldn't be so
foolish or insincere to pay attention to this political pandering, but
then only recently those Dallas pharmacists refused to fill
prescriptions for contraceptives
because of "personal beliefs." What's with the medical activism?
I disagree with the blanket statement that "Catholics hate all sorts of people"
The point about the Hippocratic Oath requires some clarification.
It is widely believed that all doctors take The Hippocratic Oath.
That is not the case. Also, there are many different versions of
the Oath. Some, for example, delete the reference to
abortion. Implicit in his statement is an important point,
though. Physicians have their own code of ethics, and most would
-- narcissistically or otherwise -- place their own ethical principles
above any legislation. It sounds as though Kriston has this
Henry Lewis at Just Left of Center adds the following
Michigan, it will soon be okay to refuse health care and coverage to gays, if you don’t like them. Well,
at least it’s still illegal to drag us out of our houses and shoot us.
Lisa at Fuzzy Puppy snarls at the Michigan Congress thus
EXPLODES, SENDING TINY SHARDS INTO MINE EYES, BLINDING ME FOREVER, FOR
WHICH I AM GLAD
As Atrios notes, it is indeed the
Taliban in America. Of course, I've been saying that for years. There
is no real difference between the god-fearing Christians here and the
Islamic fundamentalists Over There. Not really. They should all get
together over a nice hot book-burning fire sometime.
Lachlan (who has what she calls a wee bio
) posts on her site, my so-called blog
, a wee objection
to the Legislation:
I cannot imagine,
for the life of me, why this bill was sponsored. Marriage
rights being denied- ok, that’s not going to kill anyone. But denying
medical care to a segment of the population??
towards the bottom, ticks me off especially:
A. Long, vice president for public policy for the Michigan Catholic
Conference, said the bills promote the constitutional right to
“Individual and institutional health care
providers can and should maintain their mission and their services
without compromising faith-based teaching,” he said in a written
So, placing one’s
faith above another’s life is acceptable.
are religious people of all stripes going to realize that beneath
economics, faith, politics, sexuality, and gender we are all HUMAN?
That that shared humanity links us, inextricably, and should not be
dismissed in favor of societal trappings?
while part of our identities, should not be the basis for denying
medical care. Each person is loved by someone, has feelings and
Unless, of course,
you’re a gay MI resident and this law passes.
On Alex: tipping the balance
legislation was written to provide an out for medical
care professionals who are morally offended by treating gay patients
(and probably abortion procedures as well). But let’s think about the
statement, “This bill allows health care workers to refuse service to
anyone on moral, ethical or religious grounds.” What could be any less
ethical than for a medical professional to deny health care to any
patient for any reason?
medical professionals are going to start this kind of crap, then
they do not belong in the medical field. I would suggest that this
brings the word sanctimony to a stunning new level.
There are other comments by other bloggers, but I think the ones cited
here cover most of the points raised in the Blogosphere. Of note,
I included all of the comments I found that were favorable to the
Legislation, and that is a small number. The overwhelming
majority of those who wrote posts, and whose posts could be found using
Waypath and Bloglines, are negative. Many are strongly
There is one point that I did not see in any of the entries I
surveyed. From the Legislation:
health care provider shall not make an objection known to or in the
presence of a patient who is or may be the subject of the health care
service to which the health care provider is
This is bizarre, truly. Especially when you consider that
violations of the Legislation can be costly:
A person who
violates this act is responsible for a state civil infraction and may
be ordered to pay a fine of not more than $1,000.00 for each day the
violation continues or a fine of not more than $1,000.00 for each
I am not an attorney, but this would appear to mean that if a health
care provider refuses to perform a service, and tells you to your face
that he or she is refusing as a conscientious objection, then that
provider could be fined $1000. So, not only can the provider
refuse to do something on moral grounds, the provider is not allowed to
tell you why. The Senate bill was passed by a vote of 69 to
35. So 104 of our State's most distinguished citizens sat around
and passed legislation making it illegal to tell someone why you are
being obstinate. I can understand why the 35 voted against it, I
guess; but frankly, it is hard to image that anyone would even take
this seriously, much less vote for it.