Rule will strengthen right to refuse care

The Baltimore Sun

WASHINGTON - The Bush administration is planning to announce a broad new "right of conscience" rule permitting medical facilities, doctors, nurses, pharmacists and other health care workers to refuse to participate in any way in morally "objectionable procedures" such as abortion and possibly including birth control and artificial insemination.

For more than 30 years, federal law has dictated that doctors and nurses may refuse to perform abortions. The new rule would go further by making clear that health care workers may also refuse to provide information or advice about abortion to patients.

It also seeks to cover far more employees. For example, in addition to a surgeon and a nurse in an operating room, the rule would extend to "an employee whose task it is to clean the instruments," the draft rule said.

Health and Human Services Department officials said it will apply to "any entity" that receives federal funds. It estimated 584,000 entities could be covered, including 4,800 hospitals, 234,000 doctor's offices and 58,000 pharmacies.

Proponents of the rule, including the Christian Medical Association and the U.S. Conference of Catholic Bishops, say it is not limited to abortion. It will protect doctors who do not wish to prescribe birth control to unmarried girls or to provide artificial insemination, said Dr. David Stevens, the president of CMA.

"The real battle line is the morning-after pill," he said. "This prevents the embryo from implanting. This involves moral complicity. Doctors should not be required to dispense a medication they have a moral objection to."

Critics of the rule say it will sacrifice patients' health to the religious beliefs of providers.

The American Medical Association and the American Hospital Association urged HHS last month to drop the regulation. The Planned Parenthood Foundation and other backers of abortion rights condemned the rule as a last-gasp effort by the Bush administration and said the rule would allow politics and ideology to compromise health care.

Despite the controversy over the rule, HHS Secretary Michael O. Leavitt said he intends to issue it as a final regulation before the Obama administration takes over.

If the regulation is issued before Dec. 20, it will be final when the Obama administration takes office, HHS officials say. The new administration would then have to begin new rule-making procedures to overturn it.

Abortion rights advocates think it might be easier to get Democrats in Congress to reject the rule. Democratic Sens. Hillary Clinton of New York and Patty Murray of Washington have said they will move to reverse it. The HHS proposal has set off a sharp debate about medical ethics and the duties of health care workers.

Last year, the American College of Obstetrics and Gynecology said a "patient's well-being must be paramount" when a conflict arises over the moral beliefs of a medical professional.

"Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients [or] negatively affect a patient's health," the organization's Committee on Ethics said. It also said physicians have a "duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request."

Leavitt said the American College of Obstetrics and Gynecology threatened to brand as "unprofessional" those who do not share its attitudes toward abortion. In August, he criticized "the development of an environment in the health care field that is intolerant of individual conscience, certain religious beliefs, ethnic and cultural traditions and moral convictions."

In announcing its proposed rule, HHS said it was needed because of "an attitude that health care professionals should be required to provide or assist in the provision of medicine or procedures to which they object, or else risk being subjected to discrimination."

In a media briefing, Leavitt said the rule was focused on abortion, not contraception. But others said its broad language goes beyond abortion.

Judith Waxman, a lawyer for the National Women's Law Center, said Leavitt's office has extended the law far beyond what was understood before. "This goes way beyond abortion," she said. It could reach disputes over contraception, sperm donations and end-of-life care. "This kind of rule could wreak havoc in a hospital if any employee can declare they are not willing to do certain parts of their job," she said.

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