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Physician-Only Restriction

Only a physician, including a doctor of osteopathy, licensed by the state to practice medicine in the state may perform an abortion. Md. Code Ann., Health-Gen. § 20-207 (Enacted 1970; Last Amended 1982); Md. Code Ann., Health-Gen. § 20-208 (Enacted 1991).

Refusal to Provide Medical Services:

Abortion Refusal Clause
Maryland allows certain individuals or entities to refuse to provide abortion services.

To whom does the refusal clause apply?
Individuals and hospitals.

What does the refusal clause allow?
No person may be required to participate in, or refer to any source for, medical procedures that result in an abortion. No hospital may be required to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in an abortion. The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

A health care provider or hospital is not immune from civil liability or recriminatory action if the refusal to refer caused death or serious physical or long-lasting injury to the woman and was otherwise contrary to the standards of medical care.

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.

Has a court considered the constitutionality of this law?
A court has interpreted this law’s use of “refer” to apply only to the refusal to refer patients and not to protect a hospital’s refusal to send residents outside of the hospital to gain clinical experience in abortion services. St. Agnes Hosp. of Baltimore, Inc. v. Riddick, 748 F. Supp. 319 (D. Md. 1990).

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).

Contraceptive Equity Refusal Clause

Although Maryland 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 issuers of its health insurance plans exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?
Yes. By failing to define the term “religious employer,” the law’s refusal clause inappropriately includes a wide range of entities that perform non-religious functions 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 employees reasonable and timely notice of the exclusion.

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.

MD. Code Ann., Ins. § 15-826 (Enacted 1998).

Sterilization Refusal Clause
Maryland 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 person may be required to participate in, or refer to any source for, medical procedures that result in sterilization. No hospital may be required to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in sterilization. The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

A health care provider or hospital is not immune from civil liability or recriminatory action if the refusal to refer caused death or serious physical or long-lasting injury to the woman and was otherwise contrary to the standards of medical care.

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.
Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).

Artificial Insemination Refusal Clause

Maryland allows certain individuals or entities to refuse to perform or participate in artificial insemination procedures.

To whom does the refusal clause apply?
Individuals and hospitals.

What does the refusal clause allow?
No person may be required to participate in, or refer to any source for, medical procedures that result in artificial insemination. No hospital may be required to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in artificial insemination. The refusal to participate, permit, or refer 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.

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).

Restriction on Young Women’s Access to Abortion

Maryland 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 notice?
Notice.

Who must be notified?
One parent.

Are there other trusted adults who may be notified instead?
No.

What is the process for obtaining notification?
A young woman may not obtain an abortion unless the attending physician gives notice to a parent, unless the young woman does not live with a parent and a reasonable, but unsuccessful effort has been made to give notice to a parent. A postal receipt showing that mail was sent by certified mail to the last known address of a parent is conclusive evidence of notice or a reasonable effort to give notice.

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 has discretion to perform an abortion for a minor when, “in the professional judgment of the physician,” parental “[n]otification would not be in the best interest of the minor.”

May the parental mandate be waived under any other circumstances?
Yes. There are three situations in which a physician has discretion to perform an abortion for a minor without parental notification. The physician would make the professional judgment that either: (1) notice to the parent may lead to physical or emotional abuse of the minor; (2) the young woman is mature and capable of giving informed consent to an abortion; or (3) notice would not be in the best interest of the young woman.

Are there other significant requirements under the law?
No. The law does not contain a judicial bypass procedure.

Has a court considered the constitutionality of this law?
No.

Md. Code Ann., Health Gen. § 20-103 (Enacted xxxx; Last Amended xxxx); Md. Code art. 1, § 24 (Enacted xxxx; Last Amended 2002).

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