The Bush administration says new ethics guidelines written by the American College of Obstetricians and Gynecologists may violate federal "conscience" laws.
The guidelines require physicians to make referrals for abortions or other procedures they don't wish to perform themselves. But there is still confusion over whether a doctor would actually lose his or her certification as a specialist for refusing to make a referral.
At issue is an opinion released in November by the ACOG ethics committee. Among other things, it says physicians "have the duty to refer patients in a timely manner to other providers if they do not feel they can in conscience provide the standard reproductive services that patients request."
Ob/Gyn Wendy Chavkin of Columbia University welcomes the new AGOG ethics statement. She's the immediate past chairwoman of Physicians for Reproductive Choice and Health.
"It says that if a physician has a personal belief that deviates from evidence-based standards of care they have to tell the patient that, and that they do have a duty to refer patients in a timely fashion if they do not feel comfortable providing a given service," Chavkin says.
She says it isn't just about abortion, but also about things like emergency contraception — high doses of regular birth control pills that can prevent pregnancy in most cases if taken within 72 hours. She points to a scenario in which a woman has been raped and shows up at the only health care facility in her area.
"And she comes upon some doctor who thinks that emergency contraception is the equivalent of abortion, which is incorrect, but nonetheless what this individual believes," Chavin says. "What this ACOG statement is saying is she should not be deprived of something that's needed right away to take care of her emergency situation."
But doctors who object to providing certain types of care — particularly abortion — also object to referring patients.
"I'm not going to refer someone to a hit man to put to death someone that's inconvenient in their life," says Joseph DeCook, a retired Ob/Gyn from Holland, Mich., and vice-president of the American Association of Pro-life Obstetricians and Gynecologists. "I wouldn't do that. This is the very same thing. I'm not going to refer a pregnant woman to a physician who will purposefully terminate her pregnancy — better known as purposefully kill the unborn child. I'm just not going to do it."
DeCook's organization complained that the American Board of Obstetrics and Gynecology, which certifies doctors, has now said it can refuse or revoke certification for physicians who fail to abide by the new ACOG ethics statement. And that's when federal officials stepped in.
On Friday, Health and Human Services Secretary Mike Leavitt sent a letter challenging the policy to both the certifying board and ACOG.
"We had great concerns that technically competent, skilled, highly trained physicians could be denied board certification solely on the basis of refusing to refer for abortions, something that might be against their moral compass or ethical standard," says Don Wright, HHS principal deputy assistant secretary.
And it would be a violation of federal law, which has long protected the right of providers not to perform abortions. Since 2004, the law has also protected those who don't refer patients for abortions or other services.
But it's not entirely clear that board certification would — or even could — be stripped from doctors who don't want to make abortion referrals.
Officials from the certifying board weren't available for comment.
But Greg Phillips, a spokesman for ACOG, says that the November ethics opinion was just that — an opinion. He says it's not a formal part of group's code of ethics that board certified Ob/Gyns must obey.