Conscience Protection or Patient Deception? by Dr. Rick Bayer
In last minute pandering to anti-choice Republicans, former-President George W. Bush announced his ‘conscience protection’ administrative rule for the healthcare industry. Compared to prior rules allowing healthcare workers to refuse to provide abortion or sterilization for moral or religious reasons, Bush’s January 19, 2009 rule expanded the number of healthcare workers and institutions that may refuse to serve or even refer patients.
Bush’s Health and Human Services Secretary, Mike Leavitt said, “This rule protects the right of medical providers to care for their patients in accord with their conscience.” Critics, including me, say the new rule is too broad and threatens patients.
WebMD.com www.webmd.com/news/20081219/new-conscience-rule-controversy says Bush’s rule covers an estimated 571,947 entities including doctors’ offices, pharmacies, hospitals, insurers, medical and nursing schools, labs, nursing homes, and state governments. Each must certify they will comply or risk losing federal payments like Medicare.
Of course, the Catholic Health Association, representing Catholic hospitals, strongly supports the rule. Catholic hospitals and health systems that include health insurance plans are large employers who provide healthcare for about one-sixth of Americans. In Oregon, they also employ doctors who sign contracts censoring doctors and demanding the doctor abstain from certain types of care.
Bush’s rule applies not only to abortion. It also applies to birth control, emergency contraception or morning-after pills, fertility efforts, sterilization, stem-cell research, access to Death with Dignity Laws, and medical marijuana. The rule means providers do not have to inform patients of all options or offer referral, which is unethical. Religious dogma frequently conflicts with modern scientific medicine. Unethical doctors allow religion to trump science while deceiving patients.
Opponents to Bush’s rule include the American Medical Association (AMA), American Nurses Association, American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, 27 state medical associations, The National Women’s Law Center, Planned Parenthood Federation of America, and the American Civil Liberties Union.
The AMA said existing laws protect health care workers from participating in practices workers find morally objectionable. However, Bush’s new rule, “expands the range of health care institutions and individuals who may refuse to provide services, and broadens the scope... beyond the actual provision of health care services to information and counseling about health services as well as referrals.” The AMA said the new protections are so broad, receptionists can refuse to schedule patients for medically necessary services, and people who “clean or maintain equipment or rooms” can interrupt patient care.
The National Women’s Law Center said, “This gives an open invitation by any doctor, nurse, receptionist, insurance plan, or even hospital to refuse to provide information about birth control because they believe contraception amounts to abortion.” Cecile Richards of Planned Parenthood Federation said, “We are shocked that the Bush administration chose to finalize its midnight regulation to take this parting shot at women’s health and ignore patients’ rights to receive critical health care services they deserve.”
The American College of Obstetricians and Gynecologists stated, “Today’s regulation issued by Health and Human Services (HHS) under the guise of protecting the conscience of health care providers, is yet another reminder of the outgoing administration’s implicit contempt for women’s rights to accurate and complete reproductive health information and legal medical procedures.”
The American Nurses Association has a code of ethics I share. We believe patients should make healthcare decisions based upon the patient’s belief—not those of the provider. “We don’t make God-like decisions,” said Mary Jean Schumann, director of nursing practice and policy for the ANA. “That’s not what it’s about for us. It’s about helping the patient make their own decision. ... No one appointed us to be the ultimate person to pass judgment.”
At public universities, instructors teach their medical students to share medical knowledge while treating all with respect and dignity. If one cannot perform a procedure for whatever reason, medical ethics obligates we discuss alternative solutions, including referral. Escalating culture wars now seem to trample medical ethics while religious extremism masquerades as healthcare. Concerned citizens note that persons damaged by culture wars are often labeled sinners, which conveniently dehumanizes the enemy in any war.
While religious institutions have a legal right to discriminate and deceive, it is discouraging to note how many choose hostility rather than coexistence. A provider who deceives patients by withholding information is unethical and may harm patients. Nevertheless, if the patient suffers damages, this Republican invention will not permit a patient to sue the provider.
The Obama administration can repeal the rule via lengthy process or Congress can pass a law. Connecticut, California, Illinois, Massachusetts, New Jersey, Rhode Island, and Oregon filed lawsuits. The Planned Parenthood Federation of America and American Civil Liberties Union, acting on behalf of the National Family Planning & Reproductive Health Association, also filed separate suits. Let your legislators know what you think of Bush’s parting shot in his war on science so we can overturn this rule. If a provider will not or cannot perform a procedure, an ethical provider discusses alternatives with the patient, including referral.
Richard “Rick” Bayer, MD, FACP is board-certified in internal medicine, a Fellow in the American College of Physicians (FACP), practiced, and lives in Oregon.