HHS conscience protection rule praised

The New England director of the Catholic Medical Association joined Cardinal Seán P. O’Malley in praising the newly proposed federal regulation to enforce laws protecting the conscience rights of health care workers.

The regulation by the Department of Health and Human Services, which is slated to take effect after the 30-day comment period that started when it was proposed Aug. 21, requires federally funded entities to certify that their employees will not face discrimination if they refuse to participate in procedures that offend their consciences, according to a HHS statement released the day of the proposal. Those entities must establish internal coordination with the HHS Office of Civil Rights to process discrimination complaints.

“I am totally in favor of what they are doing. It is very much needed. The conscience protection has always been there, but the regulation is bringing it to light, so it can be enforced,” said New England CMA Director Dr. E. Joanne Angelo, who is also an assistant clinical professor of psychiatry at the Tufts University Medical School. “This regulation seeks to enforce a basic code of medical ethics.”

“It is very, very important to protect the rights of conscience of those who practice medicine ethically by law,” said the cardinal. “It is important to clarify these rights for the many doctors, nurses, pharmacists and others.”

Individuals should never have to go against their moral beliefs in the practice of medicine, not only in regard to performing an abortion or referring a woman to a willing abortion provider, but also in regard to distributing contraceptives, performing sterilization, lethally overdosing elderly patients with or without the knowledge of the family, and withholding food from babies born disabled or who survived abortions -- procedures that are not uncommon in Boston-area hospitals, according to Angelo.

Protecting the ethical practice of medicine is also the best way to care for patients, which is the most important point, she said.

Aggressive pain management that skirts the line of hastening a patient’s death is a long-time practice in hospitals, but now it is becoming common in hospices, where it was unheard of a few years ago, she said. “The family comes in the next morning and they are told: ‘We set up a morphine drip overnight and we’re sorry but your loved one has died.’”

Nurses are vulnerable because doctors will write orders for them to follow, she said. “In a hospital setting, after the order is written, the nurse must be able to say in good conscience to the doctor: ‘No, I cannot give this dose to the patient because I know it would be a lethal dose and this is immoral.’”

There are several cases in Boston-area hospitals of medical professionals losing their jobs or having to seek other employment because of the attempt to force the individual to do something they did not want to do, Angelo said. “For example, one young woman doctor in a clinic practicing family medicine questioned a girl’s decision to have an abortion and she asked her to re-think it, and did not refer her for the abortion. She lost her job over it.”

Angelo has no objection to educating what an abortion is or treating a patient who has had an abortion, she said. “That is part of medical education. That is part of learning the truth and we need to know the truth, so we can make informed decisions.”

In Massachusetts, the new regulation is an important expansion of protection, said Philip D. Moran, the president of the Salem-based Pro-Life Legal Defense Fund.

Current state law has some protections for conscience, but Moran said he is very concerned that medical students in their OB/GYN residencies are being compelled to perform abortions before they can receive their certificate. In addition, practicing OG/GYN physicians who are pro-life are having their re-certifications threatened and delayed if they refuse to refer patients for abortions.

The requirement to refer serves no medical or social purpose, he said. “If you look in the yellow pages of a major city, there are four, five, six pages of abortion providers, so there is no reason why you would have to do this.”

“The proposed regulation is in line with a position statement we took in 1988 in regarding respect for nurses’ religious and ethical beliefs. The regulation endorses and enforces what our position has been -- that unless the patient’s life is in jeopardy, nurses should be allowed to excuse themselves participation in practice they object to,” said David Schildmeier, the spokesman for the Massachusetts Nurses Association.

As a part of the position, the MNA requires nurses to file their objections in writing, so that the MNA can work with their management to make sure their rights are protected, he said. The position statement also states that nurses should not impose their own objections on others, he said.

Not everyone is praising the proposed regulation.

Nancy Keenan, president of NARAL Pro-Choice America, said she remains concerned about the implications of the regulation despite the fact that the text does not include the provisions found in an earlier leaked version that abortion rights advocates said confused the definitions of abortion and contraception.

“It is clear that, in the face of growing public outrage, the Bush administration reconfigured its attack on women’s reproductive freedom. This new version drops a provision from the earlier draft, but fails to give assurances that current laws about abortion will not be stretched to cover birth control,” Keenan said.

In an Aug. 27 statement to The Pilot U.S. Sen. John F. Kerry, D-Mass., expressed a similar concern.

“Most Americans -- regardless of their position on reproductive choice -- agree that increasing access to birth control prevents unintended pregnancies, which in turn results in fewer abortions. It is utterly irresponsible for the federal government to hinder a woman’s access to contraceptive services -- and especially reckless to attempt to do it in such an underhanded way,” Kerry said.

“I strongly urge the HHS to abandon this plan as it could seriously undermine the access of millions of American women to affordable and effective reproductive health care,” he added.