ANTI-CHOICE LAWS
Refusal to Provide Medical Services
ABORTION REFUSAL CLAUSE
Maine allows certain individuals or entities to refuse to provide abortion services.
To whom does the refusal clause apply? Physicians, nurses, or other persons, or hospital or health care facilities.
What does the refusal clause allow? The refusal of a physician, nurse, or other person to perform or assist in the performance of an abortion may not be a basis for civil liability, discrimination in employment or education, or other recriminatory action. The refusal of a hospital or health care facility to permit an abortion on its premises may not be a basis for civil liability or other recriminatory action.
Does the law require the refusing entity to notify the persons affected? No.
Are there circumstances under which a refusal clause may not be exercised? No.
Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services? No.
Does the law provide a mechanism for women to otherwise obtain specific reproductive health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.
Me. Rev. Stat. Ann. tit. 22, §§ 1591, 1592 (Enacted 1973; Renumbered 1978; Last Amended 1978).
FAMILY PLANNING REFUSAL CLAUSE
Maine allows certain individuals or entities to refuse to provide family planning and birth control services.
To whom does the refusal clause apply? Private institutions, physicians, or agents or employees of such institutions or physicians.
What does the refusal clause allow? No private institution or physician or agent or employee of such institution or physician shall be prohibited from refusing to provide family planning services when such refusal is based on religious or conscientious objection.
Does the law require the refusing entity to notify the persons affected? No.
Are there circumstances under which a refusal clause may not be exercised? No.
Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for family planning services? No.
Does the law provide a mechanism for women to otherwise obtain specific reproductive health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.
Me. Rev. Stat. Ann. tit. 22, § 1903 (Enacted 1973; Last Amended 1981).
HEALTH CARE PROVIDER AND HEALTH CARE INSTITUTION REFUSAL CLAUSES
Maine allows certain individuals or entities to refuse to comply with individual health care instructions or decisions based on conscience.
To whom does the refusal clause apply? Health care providers and health care institutions.
What does the refusal clause allow? A health care provider may refuse to comply with an individual health care instruction or decision for reasons of conscience. A health care institution may refuse to comply with an individual health care instruction or health care decision if the instruction or decision is contrary to a policy of the institution that is expressly based on reasons of conscience.
Does the law require the refusing entity to notify the persons affected? Yes. A health care provider or health care institution that refuses to comply with an individual health care instruction or health care decision must promptly inform the patient.
Are there circumstances under which a refusal clause may not be exercised? No.
Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for the requested health services? No.
Does the law provide a mechanism for women to otherwise obtain specific reproductive health services, information, or referrals if an individual and/or entity exercises a refusal clause? Yes. A health care provider or health care institution that refuses to comply with an individual health care instruction or health care decision must (1) inform the patient promptly; (2) make all reasonable efforts to assist in the transfer of the patient to another health care provider or institution that is willing to comply with the instruction or decision; and (3) provide continuing care to the patent until the transfer is accomplished or until it appears that a transfer cannot be accomplished.
Me. Rev. Stat. Ann. tit. 18-A, § 5-807 (Enacted 1995).
INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE
Although Maine law requires health insurance plans that cover prescription drugs to provide equitable coverage for contraception, certain employers and/or insurers may require that their plans exclude coverage for contraception.
To whom does the refusal clause apply? Religious employers for whom contraceptive coverage conflicts with their bona fide religious beliefs and practices.
What does the refusal clause allow? A religious employer may require that an insurer exclude coverage for contraception.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? No. The law narrowly defines the term "religious employer" as a tax-exempt church or association of churches or an elementary or secondary school controlled, operated, or principally supported by a church or an association of churches. This narrow definition is appropriately limited in scope, applying to religious entities but not broad-based entities that operate in the public sphere.
Does the law require the refusing entity to notify the persons affected? Yes. An employer exercising a refusal clause must provide written notice of the exclusion to insureds and prospective insureds.
Are there circumstances under which a refusal clause may not be exercised? Yes. A refusal clause may not be used to exclude coverage for contraceptives prescribed for reasons other than contraceptive purposes, or for prescription contraception necessary to preserve the life or health of the insured.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? No.
Me. Rev. Stat. Ann. tit. 24, § 2332-J (Enacted 1999; Last Amended); Me. Rev. Stat. Ann. tit. 24-A, §§ 2756 (Enacted 1999), 2847-G, 4247 (Enacted 1999; Last Amended 2003).
PHARMACIST REFUSAL CLAUSE
Maine allows pharmacists to refuse to fill or refill prescriptions.
To whom does the refusal clause apply? Pharmacists.
What does the refusal clause allow? Pharmacists or persons acting at the direction of pharmacists may refuse to fill or refill any prescription if unsatisfied about the legitimacy or appropriateness of any prescription presented, the validity of photographic identification, or the identity of any patient presenting a prescription or any person acting on behalf of the patient.
Does the law require the refusing individual or entity to notify the persons affected? No.
Are there circumstances under which a refusal clause may not be exercised? No.
Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for prescription services? No.
Does the law provide a mechanism for women to otherwise obtain specific reproductive health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.
Me. Rev. Stat. Ann. tit. 32, § 13795 (Enacted 1995; Last Amended 2005).
STERILIZATION REFUSAL CLAUSE
Maine allows certain individuals or entities to refuse to perform or participate in sterilizing procedures.
To whom does the refusal clause apply? Individuals and hospitals.
What does the refusal clause allow? No hospital or individual is required to perform or participate in medical procedures that result in sterilization. The refusal of a hospital or person may not be a basis for civil or criminal liability.
Does the law require the refusing individual or entity to notify the persons affected? No.
Are there circumstances under which a refusal clause may not be exercised? No.
Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for sterilizing procedures? No.
Does the law provide a mechanism for women to otherwise obtain specific reproductive health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.
Me. Rev. Stat. Ann. tit. 34-B, § 7016 (Enacted 1983).
Restrictions on Low-Income Women's Access to Abortion
Maine prohibits public funding for abortion for women eligible for state medical assistance for general health care unless, as certified by a physician, the procedure is necessary to preserve the woman's life or the pregnancy is the result of rape or incest. Me. Dep't of Health & Human Servs., MaineCare Benefits Manual, Ch. II, § 90.05-2(A) (Rev. Oct. 1, 2005) at http://www.maine.gov/sos/cec/rules/10/144/ch101/c2s090.doc.
Restrictions on Young Women's Access to Abortion
Maine law restricts young women's access to abortion.
Is the law enforceable? Yes.
Who is considered a minor? A young woman under the age of 18.
What is required - parental consent or parental notice? Consent.
Who must provide consent? One parent.
Are there other trusted adults who may provide consent instead? Yes, an adult family member.
What is the process for obtaining consent? A young woman may not obtain an abortion unless the attending physician secures the written consent of one parent, unless the physician determines that the pregnant woman is mentally and physically competent to give "informed" written consent.
May the parental mandate be waived if a young woman is a victim of rape or incest? No.
May the parental mandate be waived if a young woman is a victim of child abuse? No.
May the parental mandate be waived if a young woman's health is threatened? Yes. A physician may perform an abortion on a minor without the young woman's parent's consent if the physician obtains written consent from the minor, and the physician determines that "the minor, under all the surrounding circumstances, is mentally and physically competent to give consent."
May the parental mandate be waived under any other circumstances? Yes, the young woman may try to obtain permission from a judge.
If a young woman must obtain permission from a judge, what is the process? She must secure a court order either granting her majority rights for the sole purpose of consenting to an abortion or stating that an abortion is in her best interests.
Are there other significant requirements under the law? Yes. A young woman may not obtain an abortion without receiving counseling from a physician, psychiatrist, psychologist, nurse, physician's assistant, clergy member, or qualified counselor. Counseling must include: (1) the alternative choices for managing the pregnancy; (2) information on prenatal care, alternatives to abortion, and agencies providing assistance; and (3) the possibility of involving her parents or other adult family members. The attending physician also must inform the minor of: (1) the number of weeks of the pregnancy's duration; and (2) the risks of pregnancy and the proposed abortion procedure.
Has a court considered the constitutionality of this law? No.
Other information about the law: None
Me. Rev. Stat. Ann. tit. 22, § 1597-A (Enacted 1989; Last Amended 2003).
Targeted Regulation of Abortion Providers (TRAP)
Only a physician licensed by the state to practice medicine or osteopathy may perform an abortion. Me. Rev. Stat. Ann. tit. 22, § 1598(3)(A) (Enacted 1979; Last Amended 1993).
PRO-CHOICE LAWS
Contraceptive Equity
Maine law requires health insurance plans that cover prescription drugs to provide equitable coverage for contraception.
What is required? If a health insurance plan provides coverage for prescription drugs or outpatient medical services, it must provide coverage for all Food and Drug Administration-approved prescription contraceptives or outpatient contraceptive services.
To which insurance plans does the law apply? Individual and group health insurance policies issues or renewed on or after March 1, 2000, except for certain limited benefit policies, that provide coverage for prescription drugs or outpatient medical services.
Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage? Yes.
To whom does the refusal clause apply? Religious employers for whom contraceptive coverage conflicts with their bona fide religious beliefs and practices.
What does the refusal clause allow? A religious employer may require that an insurer exclude coverage for contraception.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? No. The law appropriately defines the term "religious employer" as a tax-exempt church or association of churches or an elementary or secondary school controlled, operated, or principally supported by a church or an association of churches. This definition is appropriately limited in scope, applying to religious entities but not broad-based entities that operate in the public sphere.
Does the law require the refusing entity to notify the persons affected? Yes. An employer exercising a refusal clause must provide written notice of the exclusion to insureds and prospective insureds.
Are there circumstances under which a refusal clause may not be exercised? Yes. A refusal clause may not be used to exclude coverage for contraceptives prescribed for reasons other than contraceptive purposes, or for prescription contraception necessary to preserve the life or health of the insured.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? No.
Me. Rev. Stat. Ann. tit. 24, § 2332-J (Enacted 1999); Me. Rev. Stat. Ann. tit. 24-A, §§ 2756, 2847-G, 4247 (Enacted 1999).
Emergency Contraception
PHARMACY ACCESS TO EMERGENCY CONTRACEPTION (EC)
Maine explicitly allows pharmacists to provide emergency contraception (EC) directly to women without a prescription. A pharmacist may dispense EC to a woman under standardized procedures or protocols developed by an authorized prescriber and the pharmacist.
A pharmacist must provide all EC recipients with a standardized fact sheet that includes the indications for use of EC, the appropriate method for using EC, the need for medical follow-up and referral information, information on sexual assault and referral information, and other appropriate information. The State Board of Pharmacy is charged with developing the fact sheet.
All pharmacists dispensing EC must first complete an EC training program that includes conduct of sensitive communications, quality assurance, referral to additional services, and documentation.
Me. Rev. Stat. Ann. tit. 32, §§ 13821-13825 (Enacted 2004).
Freedom of Choice Act
Maine has created additional protections for reproductive rights by adding an affirmative right to choose into its state law. In 1979, Maine enacted a law stating that it was the public policy of the state that an abortion after viability could only be performed if necessary to preserve the life or health of the pregnant woman and that abortions may only be performed by a physician. In 1993, Maine reaffirmed its public policy that a woman's right to privacy must not be restricted except as described in the 1979 law. John Hale, McKernan pushes bill to strengthen abortion rights, Bangor Daily News, Feb. 5, 1993. This law ensures women's access to pre-viability abortions and would remain in effect even if Roe v. Wade were overturned.
"It is the public policy of the State that the State not restrict a woman's exercise of her private decision to terminate a pregnancy before viability except as provided in section 1597-A [Maine's young women's access law]." Me. Rev. Stat. Ann. tit. 22, § 1598(1) (Enacted 1979; Last Amended 1993).
Guaranteed Access to Prescriptions
Maine law guarantees that women's birth control prescriptions will be filled. Maine law and pharmacy regulations specify that a pharmacist may refuse to fill a prescription or dispense a drug only under certain circumstances. Permissible reasons for refusal include questions concerning the legitimacy or appropriateness of any prescription presented, the validity of photographic identification, or the identity of any patient presenting a prescription or any person acting on behalf of the patient.
Me. Rev. Stat. Ann. tit. 32, § 13795 (Enacted 1995; Last Amended 2005); 02-392-19 Me. Code. R. § 11.
Protection Against Clinic Violence
A person shall not intentionally: (1) engage in the physical obstruction of a building; (2) make or cause repeated telephone calls to a person or a building with the intent to impede access to a person's or building's telephone lines or otherwise disrupt a person's or building's activities; (3) activate a device or expose a substance that releases noxious and offensive odors within a building; or (4) after having been ordered by a law enforcement officer to cease such noise, intentionally make noise that can be heard within a building and with the further intent either: (a) to jeopardize the health of persons receiving health services within the building; or (b) to interfere with the safe and effective delivery of those services within the building. Me. Rev. Stat. Ann. tit. 5, § 4684 (Enacted 1991); Me. Rev. Stat. Ann. tit. 5, § 4684-A (Enacted 1993); Me. Rev. Stat. Ann. tit. 5, § 4684-B (Enacted 1995).
OTHER LAWS
Informed Consent
A woman may not obtain an abortion until after she is advised by the attending physician of: (1) the number of weeks elapsed from the probable time of conception; (2) the risks associated with the pregnancy and the proposed abortion procedure; and (3) at the woman's request, alternatives to abortion such as childbirth and adoption and information about public and private agencies that will provide the woman with assistance to continue the pregnancy to term, including a list of agencies. Me. Rev. Stat. Ann. tit. 22, § 1599-A (Enacted 1993; Renumbered 1993; Last Amended 1993).
A court refused to preliminarily enjoin portions of a previous version of this law that required the provision of similar information. Women's Cmty. Health Ctr., Inc. v. Cohen, 477 F.Supp. 542 (D. Me. 1979).
Post-Viability Abortion Restriction
Maine's post-viability abortion restriction provides that no abortion may be performed after viability unless necessary to preserve the woman's life or health. Me. Rev. Stat. Ann. tit. 22, § 1598 (Enacted 1979; Last Amended 1993).
NARAL Pro-Choice America supports the legal framework established in Roe v. Wade and does not oppose restrictions on post-viability abortions, such as Maine's, that contain adequate exceptions to protect the life and health of the woman.
