LINCOLN — Seven years ago, Kmart pharmacist Neil Noesen became a cause célèbre for supporters of conscience rights.
Citing his Catholic faith, Noesen refused to fill a woman's prescription for birth control pills.
He then refused to tell her where she could get the prescription filled and, when she went to another pharmacy, refused to transfer the prescription.
The Wisconsin State Pharmacy Board reprimanded Noesen for his actions and the reprimand was upheld in court.
Under a proposed Nebraska law, Noesen would have been protected from any consequences, whether from his employer, the state licensing board or a lawsuit.
The proposal would offer broad protection for health care providers who refuse to provide care based on religious, moral or ethical objections.
State Sen. Pete Pirsch of Omaha, who introduced the proposal and named it his priority, said it safeguards providers' freedom of conscience.
"This is for cases where every fiber of their body is screaming out 'this is wrong,' and they're not going to be doing a good job," he said.
But others are questioning the measure's breadth and whether it appropriately balances providers' conscience rights with the rights of employers and patients.
Would it have protected, for example, the Pennsylvania admissions clerk who refused to type up lab and admissions forms for abortion patients?
Would it protect a dietitian who objects to killing animals for food and refuses to participate in anything involving meat?
Would it protect a nurse who refuses to care for an AIDS patient because of objections about the patient's homosexuality?
"You're opening up such a Pandora's box here," said Sen. Brad Ashford of Omaha, the Judiciary Committee chairman. "I don't know all of the ramifications."
Ashford said he believes the proposal should be the subject of an interim study or at least have a public hearing.
The proposal was put forth as an amendment to Legislative Bill 461. The original bill had a hearing last year but went nowhere.
Whether the bill will get out of committee for debate by the full Legislature this year remains up in the air.
Several Nebraska groups opposing abortion and supporting traditional values have made it a priority to pass the amended version of the bill.
The push comes as controversy rages nationally about whether employers can refuse coverage of contraception based on religious objections.
Nebraska, like most other states, protects health care providers and health care facilities from being required to participate in abortion.
The original LB 461 would expand that protection to employees, students, health care facilities and insurers with religious objections related to research and treatment using embryonic stem cells or fetal tissue and end-of-life care. It is similar to an Oklahoma law passed in 2010.
Pirsch said he heard from some groups that the original bill did not go far enough.
It would not apply to pharmacists who object to dispensing contraception or the "morning-after" pill, for example.
Nor would it apply in an ongoing dispute about whether state rules and regulations should require Nebraska mental health professionals to provide referrals for gay patients, if the therapists refuse to treat the patients for religious reasons.
This year's amendment, like a 2004 Mississippi law, would provide much more sweeping protection for those who assert conscience rights.
Under the amendment, health care providers could refuse to participate in any way, including providing referrals, in any type of health care or research that violates their religious, moral or ethical beliefs.
Providers would be defined to include any employee of a health care facility, as well as students and a list of specific licensed professionals. It also would include health care facilities.
Providers citing their conscience could not be disciplined, sued or discriminated against, including being moved to a different shift.
"I would describe it as a pretty significant expansion of what the original bill was," said Bruce Rieker, vice president of the Nebraska Hospital Association.
The hospital association, as well as other health care groups, is still reviewing the proposed language.
But Rieker said it appears to radically shift the employer-employee relationship. It also raises issues about providers' duties to patients.
The amendment bars consideration of whether an employee's refusal creates an undue burden or hardship.
Nor does it provide an exception for medical emergencies.
Pirsch downplayed concerns, saying hospitals are experienced in finding ways to address individual ethical issues.
Suzanne Gage of Americans United for Life said most objections relate to elective services that patients can get care from other providers.
"The access is there," she said.
Sens. Colby Coash of Lincoln and Steve Lathrop of Omaha have been trying to bring the amendment's supporters together with health care groups to work out their differences.
Coash said he wants to make sure health care professionals are not forced to do things that violate their conscience.
But he also wants to ensure that people in life-threatening situations get treated and that employers are able to make reasonable accommodations.
"I'm trying to see if there's a way forward," he said.
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