Federal Rule Lets Doctors Deny Medical Care Based on Religious Concerns

By Eliza Strickland | December 19, 2008 1:20 pm

Plan BHealth care workers who have a moral or religious objection to a medical procedure can’t be punished or discriminated against if they refuse to perform it, according to a sweeping new rule (pdf) announced by the Bush administration yesterday. The right-to-refuse rule includes abortion, but [the department of Health and Human Services] said it extends to other aspects of health care where moral concerns could arise, including birth control, emergency contraception, in vitro fertilization, stem cell research or assisted suicide. The rule will take effect the day before President George W. Bush leaves office [Baltimore Sun]. If a hospital, clinic, pharmacy, health plan, or any other medical establishment refuses to follow the new law it will forfeit all federal funding.

The rule has been eagerly anticipated by anti-abortion activists, but has raised furious objections from family planning groups and much of the medical establishment (groups such as the American Medical Association and the American Hospital Association opposed the regulation). Officials at hospitals and clinics predicted the regulation will cause widespread disruptions, forcing family planning centers and fertility clinics, for example, to hire employees even if they oppose abortions or in vitro fertilization procedures that can destroy embryos. “It is going to cause chaos among providers across the country,” said Cecile Richards of the Planned Parenthood Federation of America. The regulation could also make it difficult for states to enforce laws such as those requiring hospitals to offer rape victims the morning-after pill, experts said [Washington Post].

President-elect Barack Obama’s transition team is reportedly reviewing the rule as well as several other abortion and reproductive-health rules issued during the Bush administration. However, it won’t be easy to reverse this new rule; either Congress will have to pass a law repealing the regulation, or the new staff of the Health and Human Services Department will have to begin the lengthy rule-making process all over again.

Advocacy groups are raising passionate arguments for and against the rule, with anti-abortion groups maintaining that the rule supports religious freedom and pro-choice groups arguing that it undermines patients’ rights and could threaten women’s health. Meanwhile, mainstream medical groups say that religious arguments shouldn’t enter into the debate, and say they object to the rule because it second-guesses medical standards of professionalism. The American Nurses Association says it already has a code of ethics in place. The group believes patients should make the decisions on care based on their own beliefs — not those of the health-care provider. “We don’t make God-like decisions. … That’s not what it’s about for us. It’s about helping the patient make their own decision,” said Mary Jean Schumann, director of nursing practice and policy for the ANA. “No one appointed us to be the ultimate person to pass judgment” [CNN].

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Image: flickr / Florian

CATEGORIZED UNDER: Health & Medicine
  • Eric

    I’m in favor of the rule.

    The Hippocratic Oath requires all physicians to be mindful of their actions, and to make judgments based upon what they know to be right. The only reason this is an issue is because many professionals protest the particular treatments discussed here, and no doctor should be forced to something something that contradicts their Oath. They have chosen a profession of service, and much is demanded of them. No demand, even our own request, should override their Oath, which ensures that they won’t do anything contrary to our health if they can help it. These doctors see in each treatment something that not only contradicts their own personal objections, but something that contradicts their professional objections. For instance, doctors that refuse to perform abortions, do so because they consider the fetus as much their patient as the mother, and killing the fetus is contrary to their oath. For those that refuse to deal with contraception, they feel it is contrary to the best practices of medicine and their oath to inhibit a health part of the body from functioning normally.

    All of the treatments listed in the article above are elective and don’t have to be treated the same day. The only qualm you should be able to make is if the particular doctor in question is the only doctor qualified to perform the procedure, and most likely, these doctors probably protested the procedure when they first learned about it, they have probably never performed the procedure, and are the least qualified doctors to provide the treatment being pursued.

  • Damian

    I always have difficulty interpreting the letter of the law. I think laws are written that way.

    So I can’t speak authoritatively on this law, but some of the objections to it seem overblown. If a woman wants an abortion, I don’t think it’s going to be exponentially harder to find a doctor who is willing to perform one. If the most conveniently located doctor is opposed to abortions, (s)he probably isn’t performing them anyway. I don’t know why someone in need of such a procedure would want to go to a doctor who opposes it, and compel him or her to perform it.

    Forcing someone to do something they believe is unethical is pretty hard to defend, even if we disagree with their judgment.

    On the other hand: “Officials at hospitals and clinics predicted the regulation will cause widespread disruptions, forcing family planning centers and fertility clinics, for example, to hire employees even if they oppose abortions or in vitro fertilization procedures that can destroy embryos. “It is going to cause chaos among providers across the country,” said Cecile Richards of the Planned Parenthood Federation of America.”

    I don’t get this argument. Perhaps someone can explain it to me. If doctors who oppose abortion are not required to perform them, then why would family planning centers that offer abortion be REQUIRED to hire doctors who choose NOT to perform them? How does the law obligate clinics to hire doctors who will then refuse to do their jobs? That doesn’t make any sense, and again, I can only suppose that the letter of this law contains lots of meddling nonsense. I wish politicians could just speak in plain English.

    Is this law about freeing doctors to follow their conscience, or about telling clinics how to operate?

    For example, if I got a medical degree, and then declared that I considered ALL medicine to be morally problematic, would a hospital have to keep paying my salary, even though I totally refuse to practice any medicine whatsoever, just because I claimed medicine was against my religion? Obviously, that’s ludicrous, but it would be equally ludicrous to force a clinic to pay an abortion doctor who won’t do abortions.

    Why can’t the government just mind its own damn business? Let people who approve of abortions perform them, those who oppose them abstain from performing them, and let the clinics hire and fire whomever they want. That would be simpler, easier, and probably less controversial. In terms of reducing the overall number of abortions, it would probably be about as effective (zero).

  • Eric

    Well Damien,

    Since they are opposed to the legislation in question, they will throw out any argument they can think of and hope it sticks.

    I think that any doctor that has moral objections to any of the affected procedures would refuse to work at a facility that was providing them when he was hired, and if not that, would only accept employment at such a facility with an understanding that doing so is not his job. This law also pertains to pharmacists though, and many of them reject dispensing contraception. That is a bit stickier situation, since all pharmacists are pretty much the same, and there is no specialist pharmacies like there are specialized clinics. Some employers will hire the pharmacist, sometimes with the understanding that certain medicines will have to be prescribed by another pharmacist. Some states have passed laws that state that failure to prescribe those prescriptions if that pharmacist is the only one present are in violation of the law. I don’t know all of the particulars, but I have heard of pharmacists taking the prescription and refusing to return it. Maybe that is the policy of the pharmacy, and the customer was upset at the situation, or maybe the individual pharmacist was in the wrong, but surely requiring the pharmacy and pharmacist to return the prescription would be a less controversial fix than requiring the individual to dispense drugs they were opposed to.

  • David

    Why is this a problem? Two different sets of laws. Under current law, a clinic can fire someone for failing to do the job they were hired to do, therefor very few people opposed would apply. Under the new rule, they could apply knowing that they wouldn’t have to do their job and a clinic would not be able to fire them for that reason. Also, if a clinic refused to hire someone that was morally opposed to what the clinic did, the rejected individual could sue under anti-discrimination laws.

  • Damian

    Eric,

    The pharmacist question seems simpler, both morally and economically. As you say, one pharmacist is much like many others, so if one chooses not to dispense certain drugs, well, that’s a lot of business walking out the door and across the street. I imagine the market would quickly reach equilibrium, and the inconvenience would be relatively small.

    Taking a prescription form and refusing to give it back is theft; I don’t know how anyone could get away with doing that.

  • Patrick Axline

    I believe that any health care provider who hides behind religious beliefs or so called moral beliefs to not to deliver medical care to any patient are more immoral in that behavior than the behavior or request of the patient. If these pious health care providers find that doing their professional duties causes such a moral conflict I believe they are in the wrong line of work. Many of us find war to be objectionable, but we serve our country in time of war. Consider the health care provider who would not treat a veteran because of a moral objection to War. I clearly understand that the issue is birth control, abortion and even HIV. But when you let a genie out of a bottle like this where does it stop? I have worked in a major health care facility and have witnessed enough stupid treatment of patients by staff members prejudices of economic and perceived other moral issues that have nothing to do with patient care. Bottom line with any other employment is if you can’t or won’t do your job your gone.

  • http://www.darrsandberg.com Darr Sandberg

    There are religionists who believe that just about all medical treatment is a violation of their religious beliefs – not just contraception, but transfusions, chemotherapy, immunizations, etc. Under the new guidelines, they could refuse to perform any of the above as well.

    There are religionists who believe that certain peoples are being punished for sin through various misfortunes, and they could chose to with-hold or delay treatment for people of the wrong religion, wrong sexual orientation, or wrong race. There will at least be attempts to interpret this as an excuse to deny other medical care as well, such as hospital visitation.

    Many here have assumed that everyone has access to multiple choices for medical service providers – doctors, pharmacists, nurses, etc. That is often not the case, and those in areas with the least range of options – the fewest number of doctors and nurses and pharmacists to chose from, tend to be in places with the most polarized religiousity as well.

  • oneStarman

    ETHICAL CHOICE – I don’t think anyone should do something to which they are morally opposed. Medical professionals should not perform abortions or give transfusions or cut into flesh if their religious or moral beliefs forbid such actions. Just as if one is morally opposed to handguns; which are only used for murdering other people; and one is a Fireman – perhaps one would not want to put out the fire at the house of a gun owner. If that is ones choice that is fine. The way one exercises that choice is by finding another profession.

  • Bystander

    Why do religious people have this extreme obsession with controlling women? What’s so wrong with a woman making her own decisions? I think Bush’s new law is ridiculous. As I’ve said before, I’ll go 110% pro-life when male castration is mandatory.

    Besides that point, religion does NOT belong in the medical field or the government… or the schools. Anyone suffering from the notorious mass delusion is, imo, unfit for any profession involving health care or speaking for the public.

  • bigjohn756

    ALL religious regulations, propositions, Constitutional amendments(proposed or otherwise), etc., REMOVE individual rights. If a pharmacist, doctor or other anyone else wish to avoid injuring their own personal religious sensitivities then they must position themselves where they will not impinge on other peoples rights. If they choose to remain in a position where they are in control then they are forcing others to adhere their own personal beliefs and that is wrong. No one should be able to insist that someone else believe what they do.

  • Angela

    My problem with this law is in regards to smaller towns. If you live in a big city, odds are good that you can find a qualified health care provider to complete whatever procedure you wish. But what about those who live in small towns and only a few doctors? And what if those doctors refuse to do abortions, etc? And what if you can’t afford to drive possible many hours/ miles to the next closest doctor who will perform the procedure? Or if you’re a younger person who is technically capable of making your own medical decisions without informing/ asking your parents and you have no way to make it to the next closest location? There isn’t always another doctor/ pharmacy that is accessible to everyone in the US, so I believe that this will disproportionally affect lower income, rural and younger individuals by limiting their options in regard to their health care. And that is totally unacceptable!

  • Mary

    If phamacists choose to supply certain medications, while others are not required to, then those pharmacists can be threatened for choosing to supply it. By requiring ALL to supply it, it prevents these kinds of actions.

  • Angel O’ Death

    This is really good news. My religion forbids me to provide medical attention of any kind to the elderly, African Americans, Jews, Hispanics, Muslims, Gays, fat people and pretty much anyone I don’t like! I now have a legal mandate, muwahahahahaha!

  • Zach

    So could seventh day adventists refuse to give transfusions? Seems like I really would be justified in not hiring a doctor if they weren’t willing to do that.

  • William

    Ok then it should work both ways a doctor should be able to refuse to treat a fundie and refer them to a witch doctor or thier pastor to pray for a cure. They certainly don’t believe in evolution and all the medicine that comes from it so we should say this medicine is a lie and you should go to your healing hands creationism science for your medicine.

  • Elmer

    Many of you here are clearly bias over this topic. In fact this is indicated by the fact the title is called “Medical care” instead of controversial medical dilemmas. Let’s get something straight here; abortion, birth control, emergency contraception, in vitro fertilization, stem cell research or assisted suicide ARE NOT medical care that can harm the patient if not performed. These are duties that can be done by other doctors who are willing to do this type of profession.

    These so called “responsibility” is not even a requirement for the oath the doctors’ take. The doctors here have the duty to save lives. The topics above are not medical care that will/can not harm the patient. Thus, it is not a requirement for them to fulfill this duty. Honestly, its controversial moral grey areas at best, its not even a human right! Since when did do we have the right to say that people have no option of doing their duties when its clearly not necessary to do so?

    It does remove individual rights, heck our individual rights have been violated since the Patriot act. I’m sorry but when did birth control, emergency contraception, in vitro fertilization, stem cell research or assisted suicide become a duty to the doctors and a human right? Abortion I can understand, I’m a pro choice advocate, but to tell the doctor that birth control, stem cell research or assisted suicide is part of his/her duties is ridiculous.

    And no, this bill does not discriminate against people and overall does not affect the current situation of doctors. Honestly, telling a person they should quit their job because they refuse something that is morally grey is the equivalent of me firing a person because he/she is vegan working in fast food restaurant because she/he refuses to eat the meat.

  • http://larianlequella.com Larian LeQuella

    If god has a problem with the way we live our lives, have him tell us. I’d kindly ask the rest of you to STFU!

  • liz mann

    Does this rule mean that a vegan or buddhist can refuse to administer heparin or serve hospital meals that contain meat? It also seems that the only way this law can be constitutional is if we apply it to all professions.

  • Sean

    Elmer,

    while you make good points, your analogy is pretty bad. Firing a vegan because he/she refuses to eat meat doesn’t apply here. Firing a vegan because he/she refuses to serve meat is a more appropriate analogy – and I could easily see that as grounds for dismissal.

  • Sean

    Larian,

    I agree with you!

  • Bob Loblaw

    First of all, doctors have refused to treat in ways or give abortions before, this law just means they cannot be punished for it, so basically it is giving them something to fall back on when they’re being obnoxious and uncaring.
    If a patient wants an abortion, they should have one, obviously the law cannot decide whether they are in need of one but isn’t that up to them, not the lawmakers or the doctors? Some people would be better off with abortions. Some people should get abortions because they won’t be able to give a child a good fair life and this is just better. I am completely unabashedly pro-choice.

    On another note this law means that a pharmacist can not give out birth control if they just don’t think the person should take it. They could say ANYTHING is against their religion and not give it out and so now they cannot be punished for withholding any treatment or medicine.
    This law is stupid and is going to be harmful.

  • Law Student

    There have been many comments concerning doctors that push their religious beliefs on others by refusing certain medical care. Unfortunately, those arguments don’t really work. How many people do you know have changed their own beliefs based on what their doctor told them? Rather, this is an issue of the right to believe and practice one’s beliefs which has always been a hallmark of our constitution.

    More accurately, the issue is whether the potential limitations on medical choice outweigh the ability for doctors to refuse to perform something contrary to their deeply held beliefs. Luckily we don’t have to suffer the consequences of state health care so we have many options competing for our “business.” If a certain doctor won’t perform an abortion then find someone who will. If a doctor chooses to perform all acceptable treatments, then they get to reap the benefit of being a more marketable doctor. The key is that they have the choice to be the doctor they want to be. Certainly we can think of situations where some patients may have fewer choices like the small town resident, or military personnel at sea, but those issues can be dealt with individually without removing personal rights for doctors across the board.

    In our society people that don’t receive important medical care do so because of lack of insurance or some financial restraint, not because we don’t have enough doctors out there. Anyone evaluating this new rule should take a step back from their own political agenda and realize this law only protects rights our constitution aims to protect, and it really doesn’t “take rights away” from anybody.

  • Karen

    Eric, What Hippocratic Oath? They threw out the original Greek oath long ago. And if the institution they obtain their medical license from has one, it is not mandatory. Many new doctors don’t take an oath. or in the case of my doctor, don’t remember taking an oath. Most oaths now state they can either take a life or save it. What I find interesting, is many people still believe that doctors are required to take such an oath as the “original” Hippocratic Oath which vows to honor the health and life of the patient, not the health care system.

  • LJ

    Many people cannot simply choose to visit another doctor because our HMO system limits patient choices. Thinking about the ramifications of this regarding issues other than abortion–like teen access to birth control, single person or same-sex couple access to reproductive health services, people who have HIV, referrals for mental health conditions, reconstructive or plastic surgeries, etc.–can be scary, considering how many of us are VERY limited in our access to multiple providers and how we rely on our doctors as “gatekeepers” to almost all of our healthcare services.

  • LOOKING4ANSWER

    I don’t understand this article, because of all the comments. So may someone explain something to me. Does this mean that the physician can actually refuse service based on his/her beliefs/religion?

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  • Treena

    I don’t think certain physicians should be able to refuse aboritons, contraceptions, family planning issues etc simply based off personal and ridiculous religious beliefs. Family doctors, community doctors, ER doctors, OB/GYN, internist..none of them should be allowed to refuse any sort of care for women based off their own misguided ideas and ridiculous church dogmas. First off, if someone is such a bible-banging hyper religious fundie or staunch Catholic, that is against such simple, harmless , everyday things like contraception, maybe they shouldn’t go into pracitcing medicine..or healthcare at all! Physicians, NP’s, PA’s, and all other healthcare workers, are suppose to be advocates for their patients and find resources, treatments, cures, preventions, and methods that are best for their patients, not their own belief system. If a healthcare provider is SO against helping a woman find the right birth control, getting an abortion, getting annaul paps and pelvics, then what good is that doctor? I mean they can at least help that woman find a resource for those things . If they shut down to it entirely though, I think they are utterly useless in healthcare besides prescribing antibiotics for colds and coughs! If a physician only want to see patients for very very basic things, such as the flu, sprained ankles, and stomach aches…than that physician should go work in an urgent care, or walk-in clinic, or one of those clinics that are popping up in pharamacies like Walgrees, those types of places where the limits are very well defined and they are not long-term care providers, for good reasons. However, if a physician wants to take on long-term care of women, or emergency care of women, they NEED to be in favor and willing to take part of family planning and reproductive health for women! It is an essential part of women’s healthcare in our modern era. Nearly 100% of women use contraception, or will sometimes in their lives. It is almost as high in Catholic women! It is about 89%! Or even more now. So to deny female patients that level of care, in my opinion, is an extreme neglect of duty and violating the oath! Some methods of contraception also have been PROVEN to reduce the risk of cancer, reduce acne, reduce menstral pain and PMS and so on…so it is also important for women to consider using contracpetion…even just a a method to prevent cancer, not just pregnancy. Abortion is also an essential service. Not just because a woman might want one, which is HER choice, but because she might NEED one. I don’t think women should have to go special secret hidden places to get abortions. They should be able to make an appointment with their own provider and get it done in their doctor’s office like they do every yaer for a pelvic exam. I mean we don’t send women off to some back alley “clinic” for yearly exams do we? Of course not. No one , not even the Catholic church, would say that women don’t need annual “well woman” visits..in fact the Catholic church PROMOTES that. So whyis abortion and birth control so “hush hush??” A lot more women would get those services if their general practice, or at least their personal GYN, provided them. I am even more appalled that not all GYN’s offer those services. I was stunned when I was looking around for a GYN in my area that would implant an IUD on the same day visit. Not only shocked at how many refused to do it, sameday, but how many just flat out refused to do it! This is why so many women seek out facilities like Planned Parenthood! They are not hassel birth control, no questions asked, exam only if needed, birth control prescribed and “implanted” that same day. None of this ridiculous run around, call the insurance company, come in for a exam, come back for another exam to check “placement” options, come back for a pregnancy test, call your insurance again and see if they want you to get a prescription first then shrug off to the pharmacy and beg for your IUD to be given to you there in front of everyone, then back to the clinic, then another twenty minutes in the stirrups, probably with a doctor or providers that wasn’t the same “guy” you saw the first few times…I mean it sounds atrocious and absurd , and that is because IT IS! And that is happens TOO MUCH and TOO OFTEN! In 2012, I have nearly been put through that nonsense, and many of my friends have. Who wants to to have to go to a pharamcy, when they are already just trying to get the horrible exam and insertion over with and move on, but they have to stop at Wal-Mart or Walgreens first, wait in line, and get their IUD and then take it with them? That is beyond ludacris. That is why every doctor needs to be mandated to offer these services, right then. Same day unless there is a REAL medical reason they can’t. Of course I support a physician refusing, or making a woman undergo exams and tests, if she NEEDS to for her own health reasons, or for medical reasons cannot have certain types of birth control, or none at all. That is much different than just telling a woman she can’t get an IUD or on “the pill” or the Depo, or get a pap test, or Plan B, or a referal to a place that can do that, just because the doctor happens to be Catholic or a far right fundamentalist Christian! It isn’t up to the doctor to make those choices. If that doctor doesn’t want to use those methods in his or her own life (I say her with hesitation I can’t imagine a woman, especially an MD or DO, being against methods that are essential for other women but they DO exist!) than that doctor doesn’t have to. He has no right telling his female patients they can’t though! If someone has such nonsensical hang-ups about women’s basic healthcare, and they still want to go into medicine and healthcare, then they should go into a branch of medicine that doesn’t ever touch or deal with those issues. Such as opthamology, dermatology, dentistry, neurology, orthopedics, occupational health, or become a “food and ankle” guy! There are thousands of different branches and sects of medicine that doesnt’ require a doctor dealing with women’s reproductive medicine! And we need those doctors also! However, I stick to my guns! If a doctor is a family doctor, a GP, GYN etc…that should HAVE to do provide those services, or in the very least, refer the patient to another doctor or provider in the same office, or to a provider in the nearby area that will do all that! It should be a federal mandate included in the ACA right alongside the mandate that requires Catholic employers to pay for birth control!

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