Disputes over religion and health care land in Calif. courts

Dr. Catherine Kim of Simi Valley, Calif. can't do it. Her practice as an obstetrician-gynecologist is based on medical science. But her convictions as a born-again Christian sculpt every aspect of her life, from the Bible stories she reads to her kids before bedtime to the prayers she offers people who visit her office.Because of her beliefs, Kim won't perform abortions and won't provide emergency contraceptives that are used after intercourse. She won't give referrals either because that would be participating in acts she sees as immoral."Just like they have the right to choose, I have a right to choose," she said, suggesting that pushing doctors to mute the influence of faith on their practice is discrimination. "The doctor has the right to act and practice according to his or her convictions."The limits of that ability are being tested in showdowns involving California's highest courts, the federal government and doctors exercising what is called the right to conscience. That means they won't perform a procedure or treat a patient because of moral or religious beliefs.Ethicists and patient advocates say the right of conscience is well protected. The conflict comes when the doctor's beliefs collide with the patient's needs or wants."Your religious rights don't mean you can use them to undermine someone's civil rights. No one's rights go as far as the horizon," said bioethicist Nancy Berlinger, mapping out the battleground. "You have an absolute right to your religious beliefs as long as they're not hurting someone else."The fight tosses handfuls of controversial issues -- discrimination, healthcare access and religious freedom -- into one steaming stew. And in a way, the current debate began with gay marriage.In May, the California Supreme Court ruled gays and lesbians are entitled to the same marriage rights as heterosexuals and are protected by the same civil rights laws. Two months later, justices ruled on the case of Guadalupe Benitez, who claims doctors at a fertility clinic in San Diego County refused to inseminate her because she's a lesbian.The doctors said their Christian beliefs preclude them from offering insemination to any unmarried couple. Benitez ended up at another clinic that wasn't covered by her insurance, meaning she had to spend thousands of dollars, said her lawyer, Jennifer Pizer.In a case many expect to go to the U.S. Supreme Court, justices ruled doctors' religious rights don't allow them to discriminate against groups protected by civil rights laws. The doctors could have legally refused to perform insemination for all patients. But they can't perform the procedure for some people and not for gays and lesbians.Pizer said specialists who can't live with those choices should probably reconsider their profession."If a person has religious views that some women should become pregnant and some shouldn't, then the duty is probably on the (doctors) to avoid the conflict by focusing on another area of medicine," she said.Critics say the court tried to balance religious and civil rights but ended up looking like a juggler spinning one too many plates.The ruling could force doctors into performing procedures they believe are morally wrong, said Dr. Gene Rudd, an obstetrician-gynecologist and senior vice president of the Christian Medical and Dental Associations."Why would we want patients to force doctors to participate against their will?" he said. "It's like forcing a judge to sit in on a case he shouldn't deliberate."If the state ruling forms a border on religion's intersection on medicine, the federal government is trying to reinforce the fence that offers protection to doctors who won't perform abortions.A proposed regulation by U.S. Health and Human Services Department would take away federal funding from clinics or hospitals that don't protect the right to conscience. The rule affirms a doctor's ability to refuse to perform abortions, receive medical training related to the procedure or to refer patients who want to end a pregnancy to other doctors.The protections already exist, but the regulation is needed because medical schools, some clinics and other doctors pressure their colleagues, Rudd said. About 40 percent of the doctors in the Christian medical association said they've felt discrimination because of their faith, he said."Most of the people who are being told they have to do something against their conscience don't know they have laws to protect them," he said.Opponents worry the regulation is worded so broadly it could be used by doctors who don't want to give their patients emergency contraceptives. California Attorney General Jerry Brown wrote a letter to federal officials complaining the proposed regulation conflicts with state laws aimed at making sure people have access to birth control."Ultimately it's the patient that ends up suffering because they're denied access to services," said Christine Lyon, vice president for external affairs for Planned Parenthood of Santa Barbara, Ventura and San Luis Obispo counties. "It's a very far-reaching change to the rules."