Editorial: ‘Conscience law’ needs to honor health directives

Last year, the Idaho Legislature passed a “Freedom of Conscience for Health Care Professionals” bill that allows providers to decline service if it would offend their personal morals. Anti-abortion concerns motivated the law. The focus was on pharmacists who didn’t want to dispense emergency contraceptives, health care workers who didn’t want to be involved with abortion, or workers who wanted to steer clear of services using embryonic stem cells.

Abortion politics have also cropped up in Washington state, with unsuccessful attempts to persuade the Board of Pharmacy to adopt a “conscience clause” for pharmacists who do not want to dispense emergency contraceptives.

Our view has been to keep morality out of patients’ law-abiding decisions. If health care providers can’t stomach a state’s laws, they should practice elsewhere. Many professions call for practitioners to suspend their political and religious beliefs.

But “freedom of conscience” is the law in Idaho, and the reality is that there is little hope of rescinding it. However, the Legislature also passed a law in 2005 that protects patients’ end-of-life decisions, and there are valid concerns that the conscience law poses conflicts.

Perhaps owing to misguided concerns about “death panels” in national health care reform, a line was added to the conscience bill that included end-of-life care. This raised concerns that health care workers could, for instance, refuse to comply with a patient’s advanced care directive to forgo certain life preserving measures. Under the conscience law, health care workers can provide their employers with a list of things they find morally objectionable without fear of losing their jobs.

The potential for conflict was noted last year, but the measure passed unchanged. Out of concern, Gov. Butch Otter didn’t sign the bill, but he also didn’t return it to the Legislature within the required time, so it became law.

Since then, the worry has spread that living wills and advanced care directives would not be honored in Idaho. This has become a top legislative issue for AARP. Legal opinions are mixed on whether patient rights are in jeopardy, so the wise move would be to amend the law to provide clarification.

Early efforts to do so were bottled up by House State Affairs Chairman Tom Loertscher, R-Iona, who said he was concerned that changes would gut the conscience law. But on Tuesday, Rep. Julie Ellsworth, R-Boise, introduced a bill that met the chairman’s approval, so now there will be a hearing. The bill spells out a health care worker’s duty to comply with patients’ advanced directives.

The Legislature should adopt this bill or something similar. Advanced care directives not only reflect the wishes of patients, they are an important tool in lowering health care costs by forestalling unwanted procedures.

States should do everything they can to encourage and respect them.