As part of its far-reaching social agenda, the Bush Administration
instituted a health care regulation so sweeping and vast, its potential to
wreak havoc seems, to me, unlimited. Popular press tells this story as one
about abortion, but that’s just where the tale begins.
Clever anti-choice operatives dressed up a malicious rule as an
"anti-discrimination," measure. In actuality it promotes
discrimination against those in need of care. It enables the self-righteous to
hold patients and whole health care systems hostage to their personal,
idiosyncratic beliefs. The "conscience" rule, went into effect January
19th, 2009, and as such is not subject to the Obama Administration’s suspension
of pending rules.
The most dangerous section, 88.4 d 2, bars
health care institutions and employers from requiring "…any individual
to perform or assist in the performance of any part of a health service
program…" if it would offend his/her religious beliefs or moral
convictions. The next line stops employers from taking a person’s refusal to "perform
or assist" into account in decisions about employment, promotion,
termination, or the extension of staff privileges. The rule covers anyone
refusing to do their job for reasons of religious belief or moral conviction
— physicians, nurses, pharmacists, technicians — apparently even cleaning
and maintenance staff.
The rule makes no exception for refusals that endanger the patient, and
imposes no duty to give the employer or patient ample notice of a pending
refusal. The refusers are not even required to make sure
"non-refusing" staff are ready to cover for them during a crucial
treatment or procedure. Apparently that’s someone else’s job.
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So let’s get this straight. Anyone, anywhere, anytime, can claim an
authentic, deeply held moral objection to any health care treatment, procedure
or prescription and opt out, on the spot, leaving a patient high and dry. And
there’s not a thing the employer can do about it, because the Feds say so.
How is this not a prescription for chaos?
The righteous people at the Bush HHS spotlighted abortion, sterilization and
contraception in this rule. But their rule certainly doesn’t stop there. We
have already written about the disastrous impact this rule is likely to have on
end-of-life pain care, and especially the urgent intervention against
suffering called terminal sedation. The rule exaggerates an already significant
problem of under-treated pain by empowering health care personnel, including
those at the bedside, who have personal moral or religious beliefs opposing
aggressive pain care, regardless of the patient’s agony.
This rule could have a dramatic effect on all patients. How far could this
Jehovah’s Witnesses, one group with deeply held religious convictions,
believe the transfer of blood and blood products is sinful. I don’t think these
good people have ever sought to impose their beliefs on others, or grind health
care to a halt to accommodate their beliefs. But this rule certainly gives them
license to do that if they wish. "Sorry," the Jehovah’s Witness
nurse, technician or aide could say to a trauma patient bleeding to death in
the emergency room. "I can’t help, even to carry the blood to the bedside.
Find somebody else to go get it, or set up the IV to deliver it, or confirm
it’s the correct blood type." This sweeping rule even prohibits a
blood bank from declining to hire a Jehovah’s Witness in the first place, even
if their convictions would bar them from performing any actual work at the
Another religious denomination with strong health care convictions are
Christian Scientists, who adhere to Mary Baker Eddy’s science of Christian
healing and reject techniques of medical care. A Christian Science nurse,
technician or other hospital worker could refuse to participate in any aspect
of their job description, with full protection from the federal government.
This is just the beginning — just a few moral convictions enshrined in
established religious denominations. What about the myriad of personal,
idiosyncratic beliefs and convictions people usually keep to themselves? This
federal rule might coax these private convictions into overt demonstration,
given that we can’t discriminate against the person who refuses to do their job
because of them.
Think of people declining to participate in any procedure or treatment that
was tested on animals. Think of people who object, accurately or not, that a
treatment arose from stem cell research. Think of anything a person could
object to, then think how the objecting person could sabotage health care, put
patients at risk and leave personnel policies in taters by exercising their new
found "anti-discrimination" right.
Finally, there’s administration’s absurd estimate of the cost of its rule on
our already strained system. The estimate includes one person’s time (they
think 30 minutes will be plenty) to read the paperwork and certify that the
institution complies. Nothing more. They conclude that this modest cost will be
MORE than made up by the fantastic opportunities in health care for all the
people who might have previously thought health care was not the career for
them, because their deeply held convictions would bar them from actually
delivering services. They were so wrong! According to this crazed policy, they
should all apply for employment at their local health care institution, and
finally get the world to conform to their convictions! At last they will really
Unfortunately, patients are the unwitting victims in the service of