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Michigan

Refusal to Provide Medical Services

ABORTION REFUSAL CLAUSE

Michigan allows certain individuals or entities to refuse to provide abortion services.

To whom does the refusal clause apply?  Physicians, nurses, medical students, student nurses, or individuals who are members of, associated with, or employed by a hospital, institution, teaching institution, as well as hospitals, institutions, teaching institutions, or health facilities.

What does the refusal clause allow?  No physician, nurse, medical student, student nurse, or individual who is a member of, associated with, or employed by a hospital, institution, teaching institution, or health facility, who objects on professional, ethical, moral, or religious grounds, may be required to participate in medical procedures that result in an abortion.  The refusal of an individual to participate may not be the basis for civil or criminal liability, penalty, disciplinary action, or discrimination by a patient, hospital, institution, teaching institution, or health facility.

No hospital, institution, teaching institution, or health facility may be required to participate in abortion services, permit abortion care on its premises, or admit a woman for the purpose of providing abortion services.  The refusal of a hospital, institution, teaching institution, or health facility to participate may not be a basis for civil or criminal liability or penalty.  Previous participation or an expressed willingness to participate in abortion services may not be a basis for discrimination by a hospital, institution, teaching institution, or health facility against an individual.

A physician who refuses to give advice concerning abortion and discloses this refusal to the patient may not be liable for the refusal.  The refusal of a person other than a physician to give advice concerning abortion may not be a basis for civil liability, discipline, or discrimination.

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.

Mich. Comp. Laws Ann. §§ 333.20181 to .20184 (Previous Version Enacted 1973; Current Version Enacted 1978).

INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE

Although Michigan law requires health insurance plans that cover prescription medication to provide equitable coverage for contraception, certain employers and/or insurers may require that their plans exclude coverage for contraception.

What is the legal basis for this requirement?  Unlike other states, Michigan has not enacted a specific contraceptive coverage law.  Rather, the Michigan Civil Rights Commission issued a declaratory ruling, stating an employer's exclusion of prescription contraceptives from a health plan that covers other prescription medication violates the Elliott-Larsen Civil Rights Act, which prohibits sex discrimination.

To whom does the refusal clause apply? Religious employers for whom contraception is contrary to their religious tenets.

What does the refusal clause allow? A religious employer may require issuers of its health-insurance plans to exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? Yes.  The law defines the term "religious employer" as a non-profit organization that has the purpose of inculcation of religious values and that primarily employs and serves persons who share the religious tenets of the entity.  This definition is applies to broad-based entities that operate in the public sphere.

Does the ruling 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 provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause?  No.

Michigan Civil Rights Commission, Declaratory Ruling on Contraceptive Equity, Aug. 21, 2006, at http://www.michigan.gov/documents/Declaratory_Ruling_7-26-06_169371_7.pdf (last visited Jan. 4, 2008); Mich. Comp. Laws §37.2201 (Enacted 1976; Last Amended 1980), 37.2202 (Enacted 1976; Last Amended 1991); James Prichard, Civil Rights Commission: Drug Plans Can't Exclude Contraceptives, Assoc. Press, Aug. 22, 2006.


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