On July 11, the House Energy and Commerce Subcommittee on Health held a hearing to examine two controversial and divisive reproductive health issues—conscience clauses and parental consent for minors to receive contraceptive services. Noting that there are “vastly divergent views” on both issues, Subcommittee Chair Michael Bilirakis (R-FL) said, “I believe that it is important to have a hearing to have the opportunity to hear different viewpoints.”
The first panel discussed conscience clauses, which allow health care providers who because of religious or moral beliefs object to providing certain medical procedures, such as abortions, or prescribing certain prescription drugs, such as emergency contraception, to opt out of providing those services.
Congress has enacted various conscience, or refusal, clauses since 1973 when it first adopted the Church Amendment. That law states that individuals or entities with moral or religious objections to sterilization or abortion are not required to provide or perform such services simply because they receive federal funds.
In 1996, Congress enacted the Coats Amendment, which prohibits the federal government from discriminating against a medical residency program solely because that program refuses to provide abortion training to residents.
Additional conscience clause provisions were approved in 1997 as part of the Medicaid and Medicare programs and in 1998 as part of the Federal Employees Health Benefits Program.
At issue during the hearing was the 1996 Coats Amendment. In his opening statement, Rep. Bilirakis stated that several courts had ruled that hospitals did not qualify as health care entities under the 1996 law. “We need to amend current statute to ensure that hospitals are covered,” he said, referring to a bill (H.R. 4691) he sponsored that would expand conscience clauses to hospitals, provider-sponsored organizations, health maintenance organizations, health insurance plans, or any “other kind of health care facility, organization, or plan.”
Ranking Member Sherrod Brown (D-OH) disputed the chairman’s characterization of the bill. “It expands the scope of the law from graduate programs to insurance companies and HMOs,” he said, calling the bill “egregious and irresponsible.”
The subcommittee heard testimony from Karen Vosburgh, director of the association board at Valley Hospital in Palmer, Alaska, who testified in support of conscience clauses based on her hospital’s experience. In the early 1990s, the hospital board voted to stop providing abortions except in cases of rape, incest, or life endangerment to pregnant women. A local doctor subsequently sued the hospital and won. The case was appealed to the Alaska Supreme Court, which upheld the lower court’s ruling that because the hospital was a quasi-public entity it was required to provide abortion services.
“This court decision potentially places all hospitals in our state in a ‘Catch-22’ situation,” stated Ms. Vosburgh. “If you are a religious hospital, you have no First Amendment claim of religious freedom, so you must provide abortions.”
Catherine Weiss of the ACLU Reproductive Freedom Project disagreed. “The refusal of such institutions to abide by reproductive health mandates directly affects employees, patients, enrollees, and customers of diverse backgrounds and faiths,” she said, adding, “The law should not permit an institution’s religious strictures to interfere with the public’s access to reproductive health care.”
Ms. Weiss called H.R. 4691 a “dangerous measure,” saying it “amounts to a broad non-compliance permit for religiously affiliated entities that serve the general public and receive public funds.”
Professor Lynn Wardle of Brigham Young University defended conscience clauses, saying, “The private choice to decline to participate in abortion deserves no less protection than the choice to participate in abortion.” Adding that “judicial interpretation of these statutes has been very grudging, even hostile,” Professor Wardle called for consideration of H.R. 4691, which he said would “begin to eliminate the intolerance, coercion and discrimination against health care participants who do not believe in participating in the provision of abortion and other morally controversial procedures.”
The second panel discussed the issue of parental consent for minors seeking contraceptive services. Under Title X, the nation’s family planning program, minors may seek confidential care and obtain contraceptive services without parental notification or consent. Title X clinics are required to adhere to state laws regarding the reporting of statutory rape, incest, and sexual abuse or molestation.
Rep. Joseph Pitts (R-PA) criticized the Title X program. “It is abhorrent that while a child cannot receive an aspirin in school without parental consent, they can receive contraceptives.”
Rep. Lois Capps (D-CA) countered, “I can tell you from my experience that parental consent requirements for Title X will result in higher teen pregnancies rates, period.”
Addia Wuchner of Kentucky testified in support of parental consent within the Title X program. “The fact is that Title X blocks parents’ rights and responsibilities to monitor their children’s health,” she said, adding, “Government agencies and counselors cannot replace and should not interfere with the rights and responsibilities of parents, particularly in sensitive matters dealing with human sexuality.”
Testifying on behalf of the American Academy of Pediatrics, Dr. Renee Jenkins discussed the importance of confidential care for adolescents. “Allowing confidentiality of care for adolescents does not preclude the involvement of parents, as it is sometimes presumed,” she said, adding, “To the contrary, research has shown that adolescents often voluntarily share information with their parents and clinical experience confirms that this often occurs after they consult privately with their health care provider.”
Dr. Jenkins also stated that mandatory parental consent or notification would affect adolescent decision-making. “A teen struggling with concerns over his or her substance abuse, emotional well-being, or sexual health may be reluctant to share these concerns with a parent for fear of embarrassment, disapproval, or possible violence,” she said.
John Eisler of the McHenry County Board in Illinois told the subcommittee about his county’s decision to refuse Title X funding. The decision arose after a 37-year-old teacher, who was having sexual relations with one of his 12-year-old students, took the girl to a Title X clinic to receive Depo Provera, an injectible contraceptive. The teacher was convicted and sentenced to ten years in jail. “We feel it is the parents’ right to determine if any child needs medical services….The Board of McHenry County will not circumvent the basic rights of parents by accepting federal Title X funds,” he said.