White House Revises Bush-Era 'Conscience Clause'

The Obama administration has revised controversial regulations intended to protect medical workers' moral and religious beliefs. First instituted by the Bush administration, the "conscience" rules permit health care workers to opt out of performing duties if they have moral objections. Opponents, however, said the rules were so broad they could be interpreted to let workers opt out of providing not just abortion, but also birth control, treatments for AIDS and HIV, and end-of-life care. The revisions announced today narrow the conditions under which doctors, nurses and pharmacists can refuse to provide services. Michele Norris speaks to NPR's Julie Rovner.

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MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

Today, the Obama administration waded back into the controversy over abortion. It issued new rules related to what's called the Conscience Clause. The rules are intended to strike a balance between the rights of doctors and nurses not to perform procedures that violate their beliefs and the rights of patients to obtain medical care. By issuing these news regulations, the administration repealed major parts of a rule from the Bush administration.

And for more on this, we're joined by NPR's Julie Rovner. She's here in the studio.

Julie, I know that this is complicated, so let's start by tracing a bit of history here. This goes all the way back to the 1970s?

JULIE ROVNER: Yes, it does. There are laws on the books dating back to the early 1970s, in fact, just after abortion became legal, that say hospitals and clinics that get federal funds can't force medical personnel to perform abortions or sterilizations, for that matter, if that would be contrary to his or her, quote, "religious beliefs or moral convictions."

Then over the years, Congress passed several other laws that protect, for example, Catholic hospitals and others from having to provide other services that would violate their beliefs.

But there never were actual regulations to carry out those laws or to spell out how people who think their rights have been violated can get the law enforced. So at the very end of the Bush administration - and by the very end, these are regulations that took effect on the very last day - the Bush administration issued a set of very controversial rules intended to spell all of this out.

NORRIS: And so why were those 11th hour rules so controversial?

ROVNER: Well, what critics said was that the rules were written so broadly that virtually anyone involved in the provision of health care could refuse to provide any sort of medical care for any reason - so not just abortion and sterilization but also treatment for AIDS or HIV or birth control for unmarried women, and not just doctors and nurses could be protected but also receptionists and medical technicians. Basically, anybody could throw a cog into the wheel of providing any kind of health care.

NORRIS: So what's been going on since those regulations took effect more than two years ago?

ROVNER: Well, as you might imagine, this has been a very sensitive issue. There were a lot of abortion rights and women's groups that just wanted the Obama administration to rescind the entire regulation. And there were anti-abortion groups who wanted to keep things - the regulations exactly the way they were.

So what the administration decided to do was ask for another round of public comments. And they got them, more than 300,000 of them. And in the end, they decided to rewrite the rules rather than rescind them.

NORRIS: So what exactly then did the Obama administration decide to do with this rewriting of the rules?

ROVNER: Well, basically, they went back to the original intent of the original conscience law, limiting what medical personnel can refuse to perform, to abortion and sterilization - not contraception, which of course is controversial because there're some people who believe that some types of contraception are tantamount to abortion. But they've taken that part away.

The new rules also make it clear that the conscience laws are intended to protect health care workers from having to perform procedures that violate their beliefs, not from having to serve patient that may have engaged in a behavior that those providers disapprove of. In other words, a doctor, a pharmacist can't use the conscience laws to refuse to provide birth control to an unmarried woman, for example, or to provide care to a lesbian couple trying to have a baby.

At the same time, though, the Obama administration did agree with the Bush administration that there's never really been spelled out an enforcement mechanism for people who are forced to perform procedures that violate their consciences, so they left intact the part of the regulation that spells out how the Department of Health and Human Services will investigate complaints and potentially pull federal funding from violators.

NORRIS: Does this close the controversy on this evolving issue?

ROVNER: Probably not. In fact, there are now several abortion bills in Congress and particularly in that Republican-controlled House that would further limit abortion rights. And in fact, many of those bills would write some of these conscience protections into law - some of these that were in this regulation. So I would expect to see more on this particular issue.

NORRIS: And you'll probably be back to talk to us about that again.

ROVNER: I certainly will.

NORRIS: That's NPR's Julie Rovner. Julie, thank you very much.

ROVNER: You're very welcome.

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