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Later this summer, the Obama administration is expected to announce how it will deal with controversial regulations that took effect on the last day of the Bush administration. Those new rules allow health care workers to refuse to provide care or services that conflict with their beliefs. Some in health care say if the rules are repealed, they'll close their doors rather than be forced to provide care, such as abortions, that they oppose. NPR's Julie Rovner has this report.

JULIE ROVNER: Back in April, a group of doctors and nurses held a news conference where they vowed to stop providing care rather than be forced to provide or even refer patients for abortions. John Brucalski(ph) for example, runs what he describes as a pro-life, faith-based, obstetrics gynecology practice in northern Virginia.

Dr. JOHN BRUCALSKI (Ob/Gyn): Where will these patients seek their health care if our physicians can no longer practice medicine according to our conscience while respecting the conscience of the patients who come to us?

ROVNER: But will doctors like Brucalski actually lose any conscience protections if the Obama administration repeals the Bush administration's regulations?

Dr. NANCY BERLINGER (Bioethicist, Hastings Center): Well, actually no. Conscience clauses are on the books in almost every state.

ROVNER: Nancy Berlinger is a bioethicist at the Hastings Center in Garrison, New York. She says laws protecting the rights of health care providers not to participate in procedures they object to mostly date back to the early 1970s, right after the Supreme Court legalized abortion.

Dr. BERLINGER: And 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 from having to participate in an abortion.

ROVNER: And there are federal protections, too, also mostly enacted after the Roe v. Wade abortion decision in the 1970s.

Dr. BERLINGER: The conscience clauses were put on the books to say that you would be allowed to exercise a right of conscience if a particular procedure -sometimes identified as abortion or sterilization - that there was a religious or other moral reason why you couldn't do this.

ROVNER: But former Bush administration officials say not enough health care providers know about the laws already on the books, nor do they know how to complain if they are victims of unfair discrimination for exercising their conscience rights. Joxel Garcia, for example, was the Bush administration's assistant secretary for health. He says when he was applying for a residency position in obstetrics and gynecology in the late 1980s…

Dr. JOXEL GARCIA (Former Assistant Secretary for Health): …a couple of times, I was told you cannot apply here because you won't perform terminations of pregnancy.

ROVNER: He says at the time, he didn't know there were any federal protections. Garcia, who helped write the rules, says the Obama administration should leave them in place, not only because they help raise health care workers' awareness of their rights, he says, but because they helped them enforce those rights.

Dr. GARCIA: We not only were trying to make everybody aware, we also were giving a tool, a mechanism for them to seek help.

ROVNER: But bioethicist Berlinger is among many who say the rules are simply too vague, allowing any health care worker to decline to provide virtually any service at any time based on any belief. She says at some point, health care professionals have a responsibility to put their patient's well-being first.

Dr. BERLINGER: Providers have a right, if they have a serious moral objection, to say I cannot participate in this procedure. But there are responsibilities that go along with that right. They cannot abandon the patient, and they cannot interfere with the patient's access to health care.

ROVNER: Which leave the Obama administration in a bit of a quandary. Officials can try to rewrite the rules and anger abortion rights and other health groups who find them unnecessary and potentially dangerous. Or it can eliminate them altogether and incur the wrath of pro-life health workers whose good will the president has been trying to court.

Julie Rovner, NPR News, Washington.

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