Now let's examine another moral debate that's gone on for years - the debate over abortion. Some new ethics guidelines say that if a doctor does not want to perform a medical procedure, he or she should refer the patient to somebody who will. That's the rule, anyway. And it's being challenged by the Bush administration. The administration says doctors may follow their consciences, even if that leaves the patient with no referral and no idea what to do next. But as NPR's Julie Rovner has learned, there's still confusion over whether a doctor would actually lose his or her certification as a specialist for refusing to make a referral.

JULIE ROVNER: At issue was an opinion released last November by the ethics committee of the American College of Obstetricians and Gynecologists, or ACOG. Among other things, it says that physicians, quote, "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 is the immediate past chair of Physicians for Reproductive Choice and Health. She welcomes the new ACOG ethics statement.

Dr. WENDY CHAVKIN (Columbia University; Immediate Past Chair, Physicians for Reproductive Choice and Health): It says that if a physician that 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.

ROVNER: And Chavkin says it's not just about abortion, but also things like emergency contraception, which are high doses of regular birth control pills that can prevent pregnancy in most cases if taken within 72 hours. So in her example, a woman has been raped…

Dr. CHAVKIN: And she 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. 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.

ROVNER: But doctor's who object to providing certain types of care, particularly abortion, also object to referring patients. Joseph DeCook is a retired Ob/Gyn from Holland, Michigan and vice president of the American Association of Pro-life Obstetricians and Gynecologists.

Dr. JOSEPH DeCOOK (Vice President, American Association of Pro-life Obstetricians and Gynecologists): I'm not going to refer someone to a hit man who'll put to death someone that is inconvenient in their life. I mean, I wouldn't do that. And 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, you know, purposefully kill the unborn child. I'm just not going to do it.

ROVNER: 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. Last Friday, HHS secretary Mike Leavitt sent a letter to both the board and the College of Ob/Gyn. Don Wright is the HHS principal deputy assistance secretary for health.

Mr. DON WRIGHT (HHS Principal Deputy Assistant Secretary for Health): 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.

ROVNER: And the violation of federal law, which has long protected the right of providers not to perform abortions, and since 2004, not to refer for abortions, either. But it's not entirely clear that certification would or even could be stripped from doctors who don't want to make abortion referrals. Officials from the Ob/Gyn certifying board weren't available for comment, but a spokesman for the college said that the November ethics opinion was just that, an opinion. It's not a formal part of the group's code of ethics that board certified Ob/Gyn's must obey.

Julie Rovner, NPR News, Washington.

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