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By Laura Parker, USA TODAY
Doctors are becoming more assertive in refusing to treat patients for religious reasons, expanding the list of services they won't provide beyond abortion to include artificial insemination, use of fetal tissues and even prescribing Viagra.

The shift is prompting a new round of debate in courts and state legislatures over the balance between protecting the constitutional right to religious freedom and laws prohibiting discrimination.

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More than half the states in the past two years have debated expanding legal protections for health care providers, including pharmacists who refuse to fill prescriptions for the "morning after" pill. Two states have passed them.

"We've wound up with statutes that are incredibly broad," says Alta Charo, a University of Wisconsin law professor who studies bioethics. She says the use of fetal tissue in the development of chicken pox and measles vaccines also has become an issue.
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Most disputes arise out of beginning-of-life and end-of-life issues, such as assisted suicide. No doctor is required to perform particular treatments.

The collision between religious freedom and rules against discrimination occurs when physicians perform procedures selectively, offering them to some patients but withholding them from others, says Jill Morrison, legal counsel to the National Women's Law Center.

This year in a case generating wide interest, the California Supreme Court will hear a first-of-its-kind lawsuit: fertility treatment denied to a lesbian.

In Washington state, a gay man recently settled out of court with a doctor who refused to prescribe him Viagra.

"He told me he had prescribed certain drugs for married people, but he wasn't going to do that for me," Jonathan Shuffield says. "It was very painful having the trust broken between my doctor and me."

Patrick Gillen, legal counsel for the Thomas More Law Center, a Michigan-based public interest law firm that defends religious freedom, says the political clout of gays and lesbians has led to a situation that "is ripe for conflict." Gillen says no doctors should be required to perform procedures that violate their religious faith, especially "if the patients can get the treatment elsewhere."

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