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In this country, a debate over medical ethics just got more confusing. The basic issue is a stark one. Some doctors who are pro-life say they don't want to perform abortions. They don't even want to refer patients to doctors who will perform abortions. That last part about the referrals was the subject of an NPR report yesterday. But doctors' groups say if you refuse to refer a patient to another doctor, you're violating medical ethics, and that drew a protest from the Bush administration. Now the doctor's groups have clarified their position. They still think it's an ethics violation, but they're not going to take away doctors' certifications. Here's NPR's Julie Rovner.

JULIE ROVNER: Last Friday, HHS Secretary Mike Leavitt sent a letter to the American Board of Obstetrics and Gynecology with a copy to the American College of Obstetricians and Gynecologists, or ACOG. Leavitt said he was concerned about a November ethics statement from ACOG, stating that doctors should either be prepared to perform quote, "Standard reproductive services," or else refer those patients to someone who will, and that the Ob/Gyn board had made adherence to that policy a requirement for certification. Pro-life Ob/Gyns complain that would require them to make abortion referrals, something they morally opposed. And in his letter, Leavitt said that could violate federal laws protecting health worker's conscience rights. But Norman Gant, the Ob/Gyn Board's Executive Director, says HHS got it all wrong.

Dr. NORMAN GANT (Ob/Gyn Board Executive Director): They took two and two and came up with five.

ROVNER: Gant says he would have responded sooner, but he was out of the office on a family matter. He did, however, back up what ACOG said Tuesday, which is that the ethics committee opinion regarding referrals is not a binding portion of the college's ethics code, and therefore not a factor in the decision about board certification.

Dr. GANT: We do not restrict access to our exams for anyone applying for initial certification or maintenance of certification based upon whether they do or do not perform an abortion. We do not base this upon whether they do or do not refer a patient to an abortion provider if they do not choose to do abortions.

ROVNER: Gant said he dictated a letter back to Secretary Leavitt to that effect yesterday. He added that the board has long respected the fact that its members disagree on the abortion issue. More than a decade ago, it removed abortion from the list of cases to be used in oral exams. On the other hand, he said he personally had no problem with the November ethics statement, particularly the idea that Ob/Gyns should be ethically bound to provide contraception. But apparently the Bush administration doesn't agree. In an interview Tuesday, principal deputy assistant secretary for health Don Wright said HHS would be relieved to find that the board isn't using the ethics statement for certification decisions, but as for ACOG...

Mr. DON WRIGHT (Principal Deputy Assistant Secretary for Health): We would still hope that they would revisit their position.

ROVNER: A spokesman for HHS said the department would have no further comment until it receives the board's written response.

Julie Rovner, NPR News, Washington.

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