Obama weighs patient rights vs. doctor's conscience
The administration will soon decide whether to reverse Bush's 'conscience rule.'
The Obama administration will soon face a decision, bound to be controversial, on how to balance two important principles: freedom of conscience for healthcare workers versus unfettered access to healthcare, especially reproductive services.Skip to next paragraph
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Should physicians, for instance, be able to decline to provide birth control services, without referring patients to other providers? Can an emergency-room doctor who believes that emergency contraception is morally wrong refuse to tell a rape victim that it is available?
In its 11th hour, the Bush administration last December issued a "conscience rule" to protect healthcare providers who decline to participate in services they find morally objectionable, such as abortion. That regulation would cut off federal funding to state and local governments, hospitals, clinics, and other entities that fail to accommodate workers' beliefs.
The Obama administration announced its intent to rescind the rule, but it is seeking public comment by April 9 before making a final decision. President Obama has pledged to seek common ground on contentious "life" issues.
Several federal laws have been passed since the 1970s to protect conscientious objection in healthcare, but women's health advocates and other groups say the new rule goes beyond the laws in ways that could limit access to services and endanger women's health. The attorneys general of seven states also filed suit to block its implementation.
Religious conservatives, in turn, insist the rule is essential because healthcare workers, they say, are increasingly pressured, penalized, or fired for exercising their conscience right.
The Christian Medical and Dental Associations (CMDA) highlights examples on their website, including doctors who say they were forced out or had to resign from jobs because they refused to give contraceptives to unmarried women, or to refer patients to others for abortions.
"The need for those protections just keeps getting bigger and bigger," says Richard Doerflinger, spokesman on pro-life matters for the US Conference of Catholic Bishops. The rule was overdue, he says, since no regulation had been written to implement the laws on the books.
The "immediate forcing event" for the rule, he adds, was a policy issued by the American College of Obstetricians and Gynecologists saying that doctors who refuse to provide reproductive services had a duty to refer patients to other providers or to locate their practices close to doctors who do provide them.
"Referral is more than information, it's helping people get an abortion," says Mr. Doerflinger. "In our teaching, if you are putting them on the train, you are involved – the moral problem is not solved."
Was Bush rule too broad?
On the other side, family-planning proponents say that without referrals, patients can't access care and information on health options easily.
The original laws focused on abortion, but Bush's regulation, "by not defining abortion and basically allowing individuals' beliefs about what constitutes abortion to take precedence," opens the door for providers opposed to contraceptives to include birth control, says Gretchen Borchelt, senior counsel for the National Women's Law Center (NWLC).
Low-income women particularly could be affected, many say.