Is new 'Provider Conscience' rule needed?

John Commins, for HealthLeaders Media, December 31, 2008

Before he leaves office, President George W. Bush will deliver a parting gift to the abortion rights opponents he has courted throughout his political career. It's called the "Provider Conscience Regulation," and effective Jan. 19 it will reaffirm that healthcare professionals can refuse to provide medical services—such as performing abortions and providing contraceptives—if they believe the services conflict with their religious and moral beliefs. Health and Human Services Secretary Mike Leavitt says the new rule "protects the right of medical providers to care for their patients in accord with their conscience."

"Doctors and other healthcare providers should not be forced to choose between good professional standing and violating their conscience," Leavitt says. "This rule protects the right of medical providers to care for their patients in accord with their conscience."

Actually, it's not clear what effect this new rule will have on healthcare delivery other than creating more confusion, particularly in rural areas where patients seeking advice on reproductive issues don't have healthcare access alternatives. If the sole pharmacist or OB-GYN in your small town won't provide contraceptives, for example, you're out of luck.

There already is a federal law in place that does much of the same thing as the new conscience rule. The law was enacted shortly after the 1973 U.S. Supreme Court ruling in Roe v. Wade that affirmed abortion rights. In a Dec. 18 press release, HHS said the new rule was needed to "increase awareness of, and compliance with, these laws."

HHS Assistant Secretary of Health Admiral Joxel Garcia, MD, an OB-GYN, took the vague rhetoric a step further and said in the same press release, "Many healthcare providers routinely face pressure to change their medical practice—often in direct opposition to their personal convictions. During my practice as an OB-GYN, I witnessed this first-hand." That's an astounding statement to make without details, especially if he "routinely" witnessed federal crimes and did nothing about it.

The Christian Medical Association, which praised the new rule, claims that 41% of its members who responded to their poll claimed to have been "pressured to compromise Biblical or ethical convictions." CEO David Stevens, MD, says "physicians report being forced out of medical positions, residents report loss of training privileges, and students report discrimination in medical school admissions." The CMA press release provides no details to support any of these troubling claims.

On the other side of the issue, Planned Parenthood and the American Civil Liberties Union have joined the American Medical Association, the American Hospital Association, and dozens of physician and hospital associations across the nation to urge HHS to rescind the rule, which they view as overly broad and hazy and subject to abuse. "We believe that the proposed provider conscience regulation could seriously undermine patients' access to necessary health services and information, negatively impact federally funded biomedical research activities, and create confusion and uncertainty among physicians, other healthcare professionals and healthcare institutions about their legal and ethical obligations to treat patients," 40 physicians' groups say in a letter to HHS.

For a ground-level perspective, I turned to Scott Duke, CEO at the 100-bed Glendive Medical Center in eastern Montana. "I don't think this will cause us to change anything, because it's already something we look at. Almost every hospital I know of has ethics committees that are there to address issues just like this," he says.

Duke says it makes no sense to pressure healthcare professionals to conduct procedures they find objectionable. "When you are taking care of people you don't want your staff to be uncomfortable. That is a formula for potential bad outcomes," he says.

Admittedly, it could get murky during emergency procedures, such as performing an abortion to save the life of the mother. "It is a different situation when you are in the middle of a life-threatening situation. But even then, if you have someone raising questions, somebody else can step up," Duke says.

Using Nexis, Google, Yahoo, and other search engines, I found no instances where healthcare professionals are forced to perform abortions, or other medical procedure they find objectionable. I'm not saying it's not happening. I'm just saying that after two years of scanning the national news media every day for medical news, I have not seen this come up.

If the Bush administration and advocates for this new rule want us to believe that there is a need to protect of healthcare workers to perform abortions and other objectionable healthcare procedures, then they should be willing to provide specific examples of that undue pressure, and tell us who is applying it.

Actually, I believe the pressure will come from abortion rights opponents. It's pretty hard to imagine a hospital forcing a doctor to perform an abortion. But it's not hard to imagine pharmacists, physicians, and hospitals in generally conservative rural areas getting pressure from well-placed local churches and abortion rights foes to stop providing contraceptives and information on reproductive rights and options—and to stop performing abortions.

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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