Secretary Leavitt outright refuses to offer any evidence to support these allegations; no one knows where this scenario plays out or how often. But I can say that it bears no relation to my experiences as an ob/gyn in New York City, nor does it match what my peers around the country tell me about their jobs and hospitals.
And the hundreds of physicians who submitted public comments against the regulation did not share Secretary Leavitt's view of their workplaces, either. In fact, many hospitals in the United States do not provide abortions at all, and they do not train their residents in pregnancy termination, either, not even to prepare them for emergencies.
If Secretary Leavitt had visited the hospital where I practice, he would have found that every employee knows their rights. Some will not assist women undergoing abortion. They step away from these procedures without penalty or censure. Indeed, their colleagues take on more work to protect their right to refuse.
At my hospital, Secretary Leavitt would have met a few residents who opted out of the day in their rotation when I teach abortion procedures (the majority participate). He would have seen that this did not affect their grades, their recommendations, or any aspect of their future careers.
Secretary Leavitt would have talked to the anesthesiologists on staff, some of whom prefer not to participate in abortions. He would have heard about the ways we balance the schedules to accommodate these physicians and their beliefs.
In the bookkeeping office, Secretary Leavitt would have talked to a clerk who refuses to process state Medicaid forms for abortion patients -- and another clerk who does this work for her. No harm done.
Even in medical crises, we honor employees' consciences. I wish Secretary Leavitt had been at the hospital the day that my patient Melissa* started to hemorrhage.
Because she was 16 weeks pregnant and already ill, Melissa was in a bed on the labor and delivery floor. She began to bleed. Her only treatment option was abortion; she agreed to end her pregnancy.
We could have moved her into the empty operating room across the hall for her dilation and evacuation (D&E) abortion. We did not. Instead, we put her on a gurney and took her, in pain and bleeding, on a 15-minute ride through the hospital's labyrinthine corridors to another operating room.
Why not use the room seconds away from Melissa's bed? Melissa's nurse said, "I'm not going to help you with an abortion." She refused to be in the operating room, even though she would perform no part of the procedure herself. We had two surgeons at Melissa’s side ready to go, but still we moved Melissa to a part of the hospital staffed by a nurse who did not object to abortion.
Melissa survived the balancing act between her health and her nurse's beliefs. As they are written, the laws on medical workers’ consciences sometimes put us in tricky situations, but we follow them while keeping our patients healthy. Now Secretary Leavitt has put fresh obstacles between women and the treatments they need to stay well. His regulation expands the scope of current laws, extending refusal to many more medical services and letting healthcare employees withhold even information about patients' options.
Physicians like me understand that Secretary Leavitt’s rule is, at best, a waste of time and money for the 571,947 hospitals and other healthcare providers to which it applies. At worst, the regulation will cause real harm to women and families.
We look to Tom Daschle, the incoming Secretary of Health and Human Services, and President-elect Obama to reverse Secretary Leavitt’s rule. None of us can afford the damage it will do, both to the practice of medicine and the lives of our patients.
*Her name has been changed.
]]>To denounce HHS's proposed "provider conscience" regulation, Physicians for Reproductive Choice and Health submitted the public comment below. Joining us are the American Academy of Pediatrics; American Nurses Association; American Psychiatric Association; Association of Women's Health, Obstetric, and Neonatal Nurses; and the Society for Adolescent Medicine.
Together we represent 288,400 medical professionals whose consciences demand protection for women and their health. In the letter below, we outline our objections to HHS's attempt to limit patients' access to the information and care they need.
Please act now to tell HHS to drop the regulation. You have until 5 p.m. EST on Thursday, September 26, to make your voice heard.
September 23, 2008
Brenda Destro
Office of Public Health and Science
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, SW, Room 728E
Washington, DC 20201
Dear Ms. Destro:
As physicians, nurses, and
other medical professionals, we, the undersigned, urge the Department
of Health and Human Services to rescind the "Proposed Rule Ensuring
that Department of Health and Human Services Funds Do Not Support Coercive
or Discriminatory Policies or Practices in Violation of Federal Law."
(Fed. Reg. 73, No 166, August 26, 2008). If implemented, the proposed
regulation would broaden the scope of existing federal refusal laws
by allowing healthcare providers to withhold medical information based
on their religious or moral beliefs. It would also open the door
for hospitals and physicians to deny access to or information about
contraception. The proposed regulation is unnecessary,
would damage the integrity of the relationship between healthcare providers
and patients, and would undermine the ability of women and families
to make informed reproductive healthcare choices.
As healthcare practitioners,
we are not required to perform abortions or sterilizations, and those
whose personal beliefs conflict with these procedures
can step aside without censure. However, irrespective of a provider's
individual beliefs, each healthcare professional is ethically bound
to inform patients about all of their options; and, if one cannot or
will not provide a service, each healthcare professional is ethically
bound to refer patients in a timely manner to someone who can. This
approach is essential to the appropriate provision of healthcare services;
and efforts to deny women information about contraception, sterilization,
or abortion would seriously undermine quality healthcare.
Despite the assertion that the "regulation does not limit patient access to health care," if implemented it would do just that by allowing and encouraging healthcare providers to withhold information rather than share it. The proposed regulation says it is "promoting open communication within the healthcare industry, and between providers and patients, fostering a more inclusive, tolerant environment in the health care industry than may currently exist" but it does not require disclosure by healthcare professionals of their refusal to provide a service or information. Unless healthcare professionals make some indication of their refusal, how will a patient know that she is not receiving information essential to a decision that is vital to her health? Implementation of this regulation would effectively allow health care providers' personal beliefs to override patients' right to full disclosure of accurate information and available healthcare services.
The proposed regulation would
not only damage the provider-patient relationship, inserting mistrust
where trust is essential, it would expand existing law by extending
the right to refuse health services to a broad range of healthcare workers
who are not directly involved in patient care. Receptionists could
refuse to schedule appointments; health insurance agents could refuse
to process payments; and operating room staff could refuse to clean
equipment based on religious objections to certain medical procedures
or services. The proposal estimates that the new regulations would
affect 580,000 hospitals, clinics, and other entities and cost $44.5
million to enforce. The impact that this would have on the millions
of Americans who depend on federally funded healthcare services is enormous.
Additionally, the proposed regulation fails to make explicit that healthcare providers cannot deny women contraceptives by claiming they are tantamount to abortion. By not providing a definition of abortion consistent with medical authority, the regulations leave healthcare providers and institutions free to equate certain forms of contraception with abortion. Moreover, the proposed regulation would protect the refusal to provide or discuss "other medical procedures." Someone who objects to birth control could therefore take cover in the regulation.
The proposed regulation relieves healthcare professionals of a responsibility that must be upheld: the obligation to talk with patients about all of their options and, for services which cannot or will not be provided, refer them to someone who can help them without delay. This practice is followed when treating cancer and mending broken bones; and if this principle is not held as a standard for reproductive medicine, it is a failure for patients and the health of the country.
We urge the Department of Health
and Human Services to withdraw this proposed regulation.
Sincerely,
American Academy of Pediatrics
American Psychiatric Association
Association of Women's Health, Obstetric and Neonatal Nurses
The Society for Adolescent Medicine ]]>
A few weeks ago, draft regulations
under consideration by the Department of Health and Human Services surfaced
in the press,
rules that would expand the definition of abortion to include certain
forms of birth control -- including IUDs and emergency contraception -- and
allow healthcare providers to withhold these methods from their patients.
In some cases the IUD is by far the safest and most effective method of birth control for women. I can't imagine hiding the IUD from my patients who need it, like a woman I recently treated who is living with breast cancer. Nor can I fathom treating the rape survivor in front of me without offering her EC. My patients come to me for advice and facts. Ideology should not be a barrier to their care.
But the Bush administration wants my clinic and healthcare facilities around the country "not to discriminate" against doctors or any other staff who would withhold contraception from women who rely on it to continue working, going to school, and raising the children they already have. In essence, the Department of Health and Human Services finds it both healthy and humane to hire people who don't believe in women's healthcare to provide women's healthcare. As a July 30 article in the Washington Post noted, patients' health should come first in the medical world, not religion or politics.
To urge HHS to scrap the draft
rules and protect women's healthcare, all of the major professional
associations representing physicians, nurses, and nurse practitioners
who treat women and girls have written a letter (below) to HHS Secretary
Michael Leavitt. These organizations account for roughly 410,000 medical
professionals, all of whom want the best for their patients.
Physicians for Reproductive
Choice and Health and I are working with
Sen. Hillary Clinton and other elected officials to fight the draft regulations. To spread
the word as far as we can, we are using the media and blog posts like
this one. Please join us in taking action against the Bush administration's
outrageous proposal.
And after you read the letter below, please do what you can to circulate it. Thank you.
The Honorable Michael O. Leavitt
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
July 30, 2008
Dear Secretary Leavitt:
On behalf of the undersigned health care providers and professionals, we are writing to express our grave concerns about a U.S. Department of Health and Human Services (HHS) draft proposed regulation, which we believe will threaten and restrict women's access to reproductive health and birth control services. If implemented, this regulation would upend state laws protecting women's access to care and erect barriers to obtaining basic health services, at a time when we should be working together to expand access to preventive health care.
The HHS draft regulation confuses
contraception with abortion. By doing so, it undermines our shared national
goal of reducing unintended pregnancy and abortion. The oral contraceptive
pill is the most common contraceptive method in the country, and 82%
of women have relied on oral contraceptives at some time in their lives.
Oral contraceptives, when taken consistently and correctly, are extremely
effective at preventing ovulation. Yet the proposed regulation would
threaten the state laws that improve access to contraception. Moreover,
the regulation specifically defines as problematic state laws that require
employers who offer drug benefits to cover contraception, require hospitals
to offer emergency contraception to rape survivors and require pharmacies
to fill valid prescriptions. Loss of these protections compromises women's
access to medical services and safe and effective birth control.
The proposed regulation would
redefine abortion as "any of the various procedures - including
the prescription, dispensing, and administration of any drug or the
performance of any procedure or any other action - that results in
the termination of the life of a human being in utero between conception
and natural birth, whether before or after implantation." This definition
is contrary to major medical authorities, including the American College
of Obstetricians and Gynecologists, the American Medical Association,
and the British Medical Association, which define an established pregnancy
as occurring after a fertilized egg is implanted in the lining of the
uterus. The sweeping proposed definition is so overly-broad that it
could capture a range of hormonal contraceptives and nonhormonal devices
approved by the Food and Drug Administration (FDA) to prevent pregnancy.
Furthermore, the draft regulation
expands the scope of providers who can claim objections. The meaning
of the term "assist in the performance" is broadened to include
even people tangentially related to patient care, such as those employed
to clean medical instruments, health care entities, such as HMOs, and
health insurance plans. In fact, entire institutions receiving funding
from HHS could choose to make birth control unavailable to their patients.
We urge the Administration to reconsider this detrimental regulation.
Sincerely,
American Academy of Family Physicians
American Academy of Pediatrics
American College of Nurse Midwives
American College of Obstetricians & Gynecologists
American Medical Women's Association
American Nurses Association
Association of Women's Health, Obstetric & Neonatal Nurses
Physicians for Reproductive Choice and Health
Society for Adolescent Medicine
]]>