Doctors who oppose abortion and, in some cases, birth control pills say they may stop providing care if the Obama administration follows through on threats to repeal controversial Bush administration regulations aimed at allowing health care workers to refuse to provide care that conflicts with their beliefs. Opponents of the rules point out that those health care workers have plenty of other protections to fall back on.
According to a survey conducted for the Christian Medical Association, "90 percent of those surveyed said they will quit their practices before violating their conscience," said David Stevens, the group's executive director. Repealing the rules, which officially took effect on former President Bush's final day in office, said Stevens, "sends a clear message: It's open season on health care professionals of conscience — discriminate at will."
But not so fast, says Nancy Berlinger, deputy director of the Hastings Center, a bioethics think tank in Garrison, N.Y. "Conscience clauses are on the books in almost every state," she said, in addition to being codified in a series of federal laws.
Most date back to the early 1970s, after the Supreme Court legalized abortion in the landmark ruling Roe v. Wade.
"The idea was that when abortion moved from being an illegal procedure, therefore something that you did not offer in a hospital, to being a legal procedure, therefore something that you might offer in a hospital, there was a move to protect providers — usually framed as physicians, but sometimes they're more generally written — from having to participate in abortions," Berlinger said.
But conscience laws are not always abortion-specific. Many reference sterilization; some are silent, allowing practitioners to exercise their right to opt out of providing sometimes controversial end-of-life care, in vitro fertilization, or even some birth control pills that some practitioners insist cause very early abortions by preventing fertilized eggs from implanting in a woman's uterus.
Joxel Garcia, who was assistant secretary for health in the Bush administration and helped write the regulations now at issue, said they're needed because so few health workers even know that protections exist. He didn't, he said, when he was applying to be a medical resident in obstetrics and gynecology in the late 1980s and was told point-blank not to apply to certain programs if he wouldn't do abortions.
"I didn't know at that time that those facilities that were receiving federal funds were not supposed to discriminate against me because I did not perform terminations of pregnancy or abortions," he said.
Garcia also said the regulations give health care workers "a mechanism to seek help" through the Department of Health and Human Services.
But Berlinger, like many other opponents of the rules, thinks they are so vague that they would let any health worker object to providing any service at any time for any reason — even reasons that don't necessarily stand up to scientific scrutiny.
"Words like belief," she said, "when you talk about them in the context of health care, aren't just anything you might think of. They have to be defensible. And a false belief about science or the promotion of ambiguity where things can be disambiguated," as in the idea that birth control is equal to abortion, "is not ethical."
All of which puts the Obama administration in a tight spot. President Obama has been eager to find a middle ground in the touchy abortion debate. Administration officials can try to rewrite the rules, which will undoubtedly anger abortion-rights and other women's health groups. Or they can repeal them, which will anger anti-abortion groups.
A decision is expected later this summer.