The government hears about this and intervenes--not by demanding that the lifeguard rescue all swimmers but by telling him that he does not need to notify another guard, regardless of the consequence for half of the world's swimmers. Deciding that religious freedom is what needs saving, the government proposes antidiscrimination regulations that extend its version of the right of refusal to the people who repair the lifeboats, train the guards, and insure the beach.  

Sadly, this is not a joke. Recently the Department of Health and Human Services proposed a set of regulations that claim to increase protection for healthcare workers' right to abstain from medical services to which they conscientiously object. 

These regulations represent another in a long line of cynical attempts by the Bush administration to distort science and medicine to fit its religious views and sabotage women's access to reproductive healthcare.  The new rules would broaden and strengthen the legal protections for physicians and other medical workers who refuse to provide, mention, or make referrals for abortion, sterilization, and even contraception.  

Last fall, the Ethics Committee of the American College of Obstetricians and Gynecologists (ACOG) reached different conclusions about how doctors should approach their right of refusal, recommending that their right to "conscientious objection" be balanced by patients' needs.  For example, the committee recommended that physicians who hold moral objections to the use of emergency contraception in the case of rape should refer those patients to doctors who do not share their beliefs.   

ACOG's recommendations uphold longstanding medical ethics: As doctors, we base our work on respect for patient autonomy and a belief in the primacy of patient welfare, both of which would be undermined by these regulations.  

In the Orwellian universe of these new rules, let us imagine the implications for a hemorrhaging patient and a trauma surgeon with religious objections to blood transfusion, or a physician with religiously based objections to the use of pork products and a patient in a diabetic coma in an emergency room where the only insulin available is pork-derived. The ACOG guidelines would not require these physicians to provide these services but rather to inform these patients that blood and insulin exist and refer them to doctors who would provide the urgently needed care.  

But instead of focusing on patients' health, the administration proposes to extend the protective bubble to the receptionist who refuses to schedule appointments, the health insurance agents who refuse to process payments, and the operating room staff who refuse to clean equipment based on their conscientious objections to certain medical procedures or services. 

To determine a role for the government in balancing individual conscience and patients' welfare, the Bush administration would do well to look at other nations. For example, the governments of both Portugal and South Africa have crafted policies that enable individual physicians to refuse to provide services against their consciences but require them to provide full information to the patient and all necessary referrals. Their policies also obligate the healthcare system to guarantee that patients in these cases receive the care they need. 

In the short term, the Bush administration must drop the proposed regulations, and we have only one day left in the public comment period to say so. The administration is distorting the meaning of religious tolerance so that it can impose its own beliefs on the rest of us, sacrificing women's health, medical ethics, and the patient's right to know in the process.  

If they go into effect, the regulations would endanger women and undermine the doctor-patient relationship. Whatever religious values we may hold, we must also respect our patients' right to know all of their treatment options and how to fulfill them. For us, patients come first. As a member of the medical profession, I conscientiously object to the regulations.