To denounce HHS’s proposed
"provider conscience" regulation, Physicians for Reproductive
Choice and Health submitted the public comment below. Joining us are the American Academy
of Pediatrics; American Nurses Association; American Psychiatric Association;
Association of Women’s Health, Obstetric, and Neonatal Nurses; and
the Society for Adolescent Medicine.
Together we represent 288,400
medical professionals whose consciences demand protection for women
and their health. In the letter below, we outline our objections to
HHS’s attempt to limit patients’ access to the information and care
act now to tell HHS to drop the regulation.
You have until 5 p.m. EST on Thursday, September 26, to make your voice
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September 23, 2008
Office of Public Health and
Department of Health and Human
Hubert H. Humphrey Building
200 Independence Avenue, SW,
Washington, DC 20201
Dear Ms. Destro:
As physicians, nurses, and
other medical professionals, we, the undersigned, urge the Department
of Health and Human Services to rescind the "Proposed Rule Ensuring
that Department of Health and Human Services Funds Do Not Support Coercive
or Discriminatory Policies or Practices in Violation of Federal Law."
(Fed. Reg. 73, No 166, August 26, 2008). If implemented, the proposed
regulation would broaden the scope of existing federal refusal laws
by allowing healthcare providers to withhold medical information based
on their religious or moral beliefs. It would also open the door
for hospitals and physicians to deny access to or information about
contraception. The proposed regulation is unnecessary,
would damage the integrity of the relationship between healthcare providers
and patients, and would undermine the ability of women and families
to make informed reproductive healthcare choices.
As healthcare practitioners,
we are not required to perform abortions or sterilizations, and those
whose personal beliefs conflict with these procedures
can step aside without censure. However, irrespective of a provider’s
individual beliefs, each healthcare professional is ethically bound
to inform patients about all of their options; and, if one cannot or
will not provide a service, each healthcare professional is ethically
bound to refer patients in a timely manner to someone who can. This
approach is essential to the appropriate provision of healthcare services;
and efforts to deny women information about contraception, sterilization,
or abortion would seriously undermine quality healthcare.
Despite the assertion that
the "regulation does not limit patient access to health care," if
implemented it would do just that by allowing and encouraging healthcare
providers to withhold information rather than share it. The proposed
regulation says it is "promoting open communication within the healthcare
industry, and between providers and patients, fostering a more inclusive,
tolerant environment in the health care industry than may currently
exist" but it does not require disclosure by healthcare professionals
of their refusal to provide a service or information. Unless healthcare
professionals make some indication of their refusal, how will a patient
know that she is not receiving information essential to a decision that
is vital to her health? Implementation of this regulation would
effectively allow health care providers’ personal beliefs to override
patients’ right to full disclosure of accurate information and available
The proposed regulation would
not only damage the provider-patient relationship, inserting mistrust
where trust is essential, it would expand existing law by extending
the right to refuse health services to a broad range of healthcare workers
who are not directly involved in patient care. Receptionists could
refuse to schedule appointments; health insurance agents could refuse
to process payments; and operating room staff could refuse to clean
equipment based on religious objections to certain medical procedures
or services. The proposal estimates that the new regulations would
affect 580,000 hospitals, clinics, and other entities and cost $44.5
million to enforce. The impact that this would have on the millions
of Americans who depend on federally funded healthcare services is enormous.
Additionally, the proposed
regulation fails to make explicit that healthcare providers cannot deny
women contraceptives by claiming they are tantamount to abortion.
By not providing a definition of abortion consistent with medical authority,
the regulations leave healthcare providers and institutions free to
equate certain forms of contraception with abortion. Moreover,
the proposed regulation would protect the refusal to provide or discuss
"other medical procedures." Someone who objects to birth control
could therefore take cover in the regulation.
The proposed regulation relieves
healthcare professionals of a responsibility that must be upheld: the
obligation to talk with patients about all of their options and, for
services which cannot or will not be provided, refer them to someone
who can help them without delay. This practice is followed when treating
cancer and mending broken bones; and if this principle is not held as
a standard for reproductive medicine, it is a failure for patients and
the health of the country.
We urge the Department of Health
and Human Services to withdraw this proposed regulation.