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U.S. Department of Health and Human Services.  HHS.gov  Secretary Mike Leavitt's Blog

Physician Conscience

Physician Conscience Blog III

I have on two previous occasions written in my blog about the principle of health care provider conscience. Federal law is explicit and unwavering in protecting federally funded medical practitioners from being coerced into providing treatments they find morally objectionable. This became a topical matter when the American College of Obstetricians and Gynecologists (ACOG) issued guidelines that could shape board certification requirements and necessitate a doctor to perform abortions to be considered competent.

Physician certification is a powerful instrument. Without it, a doctor cannot practice the specialty. Putting doctors (or any one who assists them) in a position where they are forced to violate their consciences in order to meet a standard of competence violates more than federal law. It violates decency and the core value of personal liberty. Freedom of expression and action are unfit barter for admission to medical employment or training.

As Secretary of Health and Human Services, I called on the organization that oversees Ob-Gyn board certification to alter its guidelines to assert that refusal to violate conscience will not be used to block board certification. Their answer was dodgy and unsatisfying.

Today, HHS will file a rule in the Federal Register aimed at increasing compliance with existing federal laws protecting provider conscience. The proposed rule clarifies that non-discrimination rules apply to institutional health care providers as well as to individual employees working for recipients of certain funds from HHS. It requires recipients of certain HHS funds to certify their compliance with laws protecting provider conscience rights. The HHS Office for Civil Rights is designated as the entity to receive complaints of discrimination addressed by the statute or the proposed regulation.

The proposed rule also charges HHS officials to work with any state or local government or entity that may be violating the law or the proposed rule to encourage voluntary steps to remedy the problem. If they fail to fix the problem, it empowers HHS officials to consider a range of sanctions including termination of funding and the return of funds paid out while they were in violation. The proposed rule is open for comment in the Federal Register for 30 days.

Our nation was built on a foundation of free speech. The first principle of free speech is protected conscience. This proposed rule is a fundamental protection for medical providers to follow theirs.

Physician Conscience Blog II

I’m delighted to announce that with the help of Planned Parenthood, my blog -- for the first time -- received more visits than my teenage son’s MySpace page. Perhaps I’ll address the subject of physician conscience one more time.

Having served as Governor for 11 years and now in my fifth year as a member of the President’s Cabinet, the debate over abortion is not a new one to me. I was not surprised by the more than 850 comments. Consistent with the comment policy, we will post all but about 25 which violated our rules because they contained what the reviewers described to me as “profane language or personal attacks on your body parts, religion or family.” This is part of an ongoing debate in our country and there isn’t much new.

One thing I did find helpful was the clear explanation of the ideological basis of opposition to physician conscience. Mary Jane Gallagher, President of the National Family planning and Reproductive Health Association, was quoted in Congressional Quarterly’s HealthBeat saying,

“Family planning providers work to provide family planning services. So it’s really not acceptable to the people I represent that this administration is considering allowing doctors and nurses and pharmacists that have received their education to provide services to now be able to not provide those services if they don’t want to.”

“Who’s going to provide access to contraceptives services if the administration provides this large loophole to deny services?"

CQ reported Ms. Gallagher continued: “Providers are ‘given an oath—now they get to pick and choose what they want to do' if a regulation is issued, she said.”

So, according to Ms. Gallagher’s ideology, if a person goes to medical school they lose their right of conscience. Freedom of expression and action is surrendered with the issuance of a medical degree.

There is something I’d like to point out to Ms Gallagher and the people she represents. It is currently a violation of three separate federal laws to compel medical practitioners to perform a procedure that violates their conscience.

Obviously, some disagree with the federal law and would have it otherwise, so they have begun using the accreditation standards of physician professional organizations to define the exercise of conscience unprofessional and thereby make doctors choose between their capacity to practice in good standing and their right of conscience. In my view, that is simply unfair and a clear effort to subvert the law in favor of their ideology.

This is not a discussion about the rights of a woman to get an abortion. The courts have long ago identified that right and continue to define its limits. This regulation would not be aimed at changing or redefining any of that. This is about the right of a doctor to not participate if he or she chooses for reasons they consider a matter of conscience. Does the National Family Planning and Reproductive Health Association believe we can protect by Constitution, statute and practice rights of free speech, race, religion, and abortion—but not conscience?

Is the fear here that so many doctors will refuse that it will somehow make it difficult for a woman to get an abortion? That hasn’t happened, but what if it did? Wouldn’t that be an important and legitimate social statement?

I want to reiterate. If the Department of Health and Human Services issues a regulation on this matter, it will aim at one thing, protecting the right of conscience of those who practice medicine. From what I’ve read the last few days, there’s a serious need for it.

Physician Conscience

Several months ago, I became aware that certain medical specialty certification groups were adopting requirements which potentially violate a physician's right to choose whether he or she performs abortion. I wrote to the organizations in question, protesting their actions.  Frankly, I found their response to be dodgy and unsatisfying. I sent another letter, more of the same.

Not only are there clear provisions in three separate laws protecting federally-funded health care providers' right of conscience, but doing otherwise undermines the most fundamental moral underpinning of freedom of expression and action. I asked that regulations be drafted which would enforce these long-standing laws protecting a medical practitioner's conscience rights.

An early draft of the regulations found its way into public circulation before it had reached my review. It contained words that lead some to conclude my intent is to deal with the subject of contraceptives, somehow defining them as abortion. Not true.

The Bush Administration has consistently supported the unborn. However, the issue I asked to be addressed in this regulation is not abortion or contraceptives, but the legal right medical practitioners have to practice according to their conscience and patients should be able to choose a doctor who has beliefs like his or hers.

The Department is still contemplating if it will issue a regulation or not. If it does, it will be directly focused on the protection of practitioner conscience.

Many have provided comments on this subject and they will all be included under this posting.

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