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The proliferation of "conscience clauses" within the country's health care system is putting women's health-care advocates in a crisis mode.

Also referred to as "refusal clauses" and "patient abandonment clauses," these addendums in state and federal laws allow the individuals and institutions women rely on for health care to withhold their services. In many cases, providers are not required to warn patients of their policies or provide referrals.

What began in 1973 when Congress said doctors receiving federal funds could refuse to perform abortions or sterilizations on religious grounds has grown into a government sanction for individuals, institutions, insurance companies and pharmacists to withhold several other kinds of health care and services.

According to the ProChoice Resource Center, today's "conscience clauses" go beyond abortion and sterilization to encompass any health services about which an ethical, religious or moral objection is raised and extend beyond providers to include corporate players such as health plans, pharmacies and private employers.

State laws exempt many in the medical community from providing everything from birth control pills, fertility treatments, family planning counseling and emergency contraceptives, even for rape victims, if they object to them on religious grounds. Employers and insurance companies are exempted from mandates to cover these services for the same reason.

New York's legislators are wrestling with a proposed women's health care bill that, in the Senate version, would excuse health-care insurance plans covering employees of religious institutions from mandated coverage of contraception and fertility treatments. The exemption is seen as a concession to Catholic organizations in the state that employ more than 200,000 women.

JoAnn Smith, director of Family Planning Advocates of New York State, says the Senate bill's religious exemptions are among the broadest in the spate of similar bills passed in seven other states. Nancy Yanofsky of the ProChoice Resource Center calls the bill "blatant discrimination and blatant bad health."

The resource center contends that protecting "the 'corporate conscience' of religious employers and health-care institutions is eclipsing the rights of patients to make decisions about legal health services based on their own individual conscience and medical needs."

Women's reproductive health-care options have been further restricted by the growth of the Catholic health-care system and its mergers with secular hospitals. The American Public Health Association contends these mergers limit women's access to a full range of reproductive health services and also restrict patients' end-of-life choices.

The association's policy statement notes that not just hospitals, but affiliated outpatient clinics, medical office buildings, nursing homes, home health care agencies and managed care plans can be affected by the adoption of religious health care rules.

A survey conducted by Catholics for a Free Choice found that 82 percent of Catholic hospitals will not provide emergency contraception to a rape victim and the majority of those will not refer the patient to another hospital or doctor.

Hoping to preserve the rights of women to full medical services, the George Gund Foundation, ProChoice Resource Center and the American Civil Liberties Union's Reproductive Freedom Project have launched the Rainbow Campaign, which will hold the first of four regional conferences Monday and Tuesday in New York City. Marcia Greenberger, co-president of the National Women's Law Center, will be keynote speaker. Panelists include doctors, lawyers, clergy and advocates.

The group hopes to shift the public debate on the conscience issue to what the Alan Guttmacher Institute calls the other side of the equation: "the ability of individuals to obtain health care services to which they are entitled, by law or under the terms of their insurance plan, in a system in which a range of key players are allowed to opt out."

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