Physicians, Nurses Oppose HHS Draft Regulations on Contraception


The Bush administration wants
women to have the worst in reproductive healthcare. As an ob/gyn, I
am proud to say that my colleagues and I won’t stand for it.

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

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  • invalid-0

    Greetings Doctor,
    Medical advice can just as easily be based on ideas that reflect a particular societal need or aspiration of the individual giving the advice, which is just as ideological as a pro-lifer telling a women that EC can cause the death of a person. Of course, EC goes beyond ideology for a pro-lifer because science tells us that EC can cause the death of a person, which is a fact. It is right in the medical literature: pre-implantation. What is being stopped if not life in those cases where Levonorgestrel fails to prevent ovulation and a conception occurs while the drug certainty still does act as an antagonist to implantation? The current medical definition will have to change if medicine is to keep pace with science, rather than resorting to ideology. Doctor, it is a scientific fact that life begins at conception. This is with what the HHS is concerned. How much DNA does a zygote have after the resulting first mitosis of union of sperm and oocyte, which is the actual fusion of the respective chromosomes of his parents, as compared to the zygotes Grandmother who just died exactly at his conception? Answer: exactly the same amount. Where does this transformation occur? Well, in the tube, before implantation. (Hum? In the tube… can anyone say ectopic pregnancy? I wonder why it is called a pregnancy in this particular case, if the child has not attached himself to the endometrium? I guess it is because he has imbedded himself in the tube. I diverge.) Sorry. Anyway, what is human necessarily has to be human at all stages of his development or he would never be human to begin with. It really is that simple. Distinguishing pregnancy from conception makes no medical sense because pregnancy would never occur without conception and the child is already in his mother, anyway. Ideology goes both ways, and it is very powerful when used properly. The issue is about life, Doctor, not an ideology as to what constitutes a pregnancy. Anyway, time to go study. Have a good day.

    Timothy+

  • invalid-0

    Can you provide any references to studies that prove life begins at conception? If not, then it’s not a scientific fact; it’s merely your belief.

    Medical advice should be based on what’s best for the patient. Restricting access to birth control is not in a woman’s best interest; there are many risks to pregnancy, and some women will become extremely sick if they become pregnant. Furthermore, it’s always in a woman’s best interest to decide the circumstances under which she wants to start a family. No one else can make that decision for her and still claim to be acting to “help” her.

  • invalid-0

    Medical advice can just as easily be based on ideas that reflect a
    particular societal need or aspiration of the individual giving the
    advice, which is just as ideological as a pro-lifer telling a women
    that EC can cause the death of a person.

    Can you explain this? I don’t understand how presenting facts to patients – ie, contraception prevents fertilization or implantation in some cases is a "particular societal need or aspiration of the individual giving the advice"?

    Your argument that life begins at conception and so therefore any procedure or medication or action that interferes with that is, well, murder is not scientific fact. That is your belief system. There is a difference. You absolutely have a right to that belief system. But it isn’t medical or scientific fact.

    It would, in fact, have tremendous consequences. If you consider conception as the beginning of life, then how would you go about ensuring that nothing happened to that "life" inside of a woman? You seem very knowledgeable. How many fertilized eggs do you think end up actually gowing through the growth process to embryo, fetus and baby? What about all of the fertilized eggs that are created through IVF? How do you propose to legislate the rights of fertilized eggs? If that is when life begins then certainly we need to ensure that they are afforded rights?

    What if there were a fire in an IVF clinic? If there are a handful of test tubes around the clinic with 20 fertilized eggs and one actual living, breathing child there – who would you save? You’d be weighing one child’s life next to the "lives" of 20 or so others? Seems logical, according to your reasoning that you’d need to save the 20 "lives" in the test tubes first?

    Until you find a way for women’s bodies to stop being fertile and inhabiting the ability to grow life, you cannot decide that life begins when you ideologically want it to and then enforce outside regulations and laws based on that to control what happens inside our bodies. 

    As long as physicians discuss how contraception works with their patients, it is up to the patients to individually decide when life begins for them and when it doesn’t and make their decisions about whether or not they will use contraception as a family planning method or not based on those decisions. 

    And since 98% of American women will use contraception at some point in their lives and since the majority of Americans do believe in ensuring access to contraception, it seems that this is a non-issue for most. 

    Amie Newman

    Managing Editor, RH Reality Check

  • invalid-0

    Amie,

    Are you suggesting that doctors routinely inform women that their prescribed contraception in some cases prevents implantation? Hmmm. Not true!

    In your zeal to protect your position, it seems a bit ridiculous to posit concern for the fertilized eggs who, by the forces of nature, do not progress through the stages of embryo, fetus and newborn. The goal is to prevent intentional assaults on life, not to stifle volcanoes.

    It seems that some modern women struggle with control issues. If they are fertile, they don’t want to be. If they aren’t fertile, they create massive numbers of embryos to make sure they have what they want when they want it. And then they complain when we don’t all want to participate in the complexities that they have created with their proclivity to dissatisfaction.

    I have never had a birth control prescription, nor an abortion; not a fertility treatment, nor a crisis pregnancy; no searing disdain for my sexuality or the sexuality of my husband. I have a wide variety of interests, and am willing to see what life throws my way. For people who like rigid schedules, and place a high priority on instant gratification of their erectile tissue, that is their preference, and they should be willing to pay for it themselves, much like those who must have a speedboat, plasma TV or an ensemble from the latest J Crew collection. Having these things does not constitute a health issue and those with a more relaxed view of human existence should not be forced into the same insurance pool or be legally obligated to cooperate professionally with such dubious “needs”.

  • invalid-0

    Having these things does not constitute a health issue and those with a more relaxed view of human existence should not be forced into the same insurance pool or be legally obligated to cooperate professionally with such dubious “needs”.

    Well, I didn’t vote for George Bush and I don’t think we should be in Iraq. Can I stop paying taxes, since that’s what’s funding the war?

  • invalid-0

    Well, you may just want to pursue that as long as you are prepared to field your own force when you notice an international situation that needs attention. Who knows? It could save you some money, cursed femaleness being expensive as it is.

  • invalid-0

    Thank you for your compliment and your time, Miss Newman. I will try to give you some of mine, and I will try to address your points in the concise bullet format, if possible.

    § When particular favorable facts correspond to a particular politically correct ideology the presentation of the facts is often skewed in the favor of the ideology by not presenting the other medical facts that correspond to the contrary ideology.
    § I never said murder. I said that EC could cause the death of a human person. I never even intimated any corporate mal-intent on the part of women for which they could be culpable legally or morally, here or hereafter, now or latter as the crime of murder necessitates.
    § As far as your points about the development of the human person, it is incumbent upon a mother not to harm her baby in all of his stages of development. This point is germane to life, not choice, because in this hypothetical case we are discussing an already existing being. What will be human must necessarily already be human or it would never be human. This is logical. It is medical. Search and you will find. Anything natural that happens to a child that ends his life is out of a mother’s control. Hence, any consideration of culpability on the mother’s part is out of the question as far as I am concerned. IVF should be outlawed and hopefully it will be, along with other such manufacturing of the human project for other humans. If there was a fire in an IVF clinic, I would save the child in front of me, as I would not have the know how to remove the test tubes from the lab, nor would I know what to do with them to keep them alive after I had removed them. I will consult my ethics book to see if I am right, though.
    § Well, it is not a non-issue or we would not be having this discussion nor would you require such an excellent organization to protect your legal rights. However, I do hope to change those rights. I do not even consider them to be rights that could ever supercede the right of another human being. Paradoxically, I see the regulations and laws are already controlling what happens to your bodies and more importantly those of others. This is obviously the dividing line between our sides. But majority votes do not make truth. Moreover, laws historically are often initiated without the majority of Americans willing them, i.e., Roe/Wade. Maybe our side will get a decision like that one in our favor and defy the majority just as Roe/Wade defied the majority. In any case, indicators are certain that this issue and others like it will have to go to the States for their consideration, as the Constitution provides recourse. This is especially true if Mr. Obama wins the presidency and pushes these issues for judgment quite easily right into the Supreme Court of our land.

    Thank you Miss Newman.

    Timothy+

  • invalid-0

    OK, as long as YOU’RE prepared to pay entirely out of pocket for any medical costs related to a gynecologic condition. (And I mean ALL costs. Hospital fees, doctor fees, medication fees, etc.) Hey, it’s all lifestyle issues, right?

  • invalid-0

    Lucille, I’m reading here what you do. You have not used prescription birth control. But one presumes (from your tone) that you have also controlled your own sexuality, no? You have decided when to have sex with your husband (or not). I’m guessing you (hopefully together with your husband) have decided if and when to have children. This is also control. What makes you better than others? The lack of chemicals involved?

    If you are so convinced that your way is the only way, I see no point to debate. However, if you concede that maybe others have different values systems from your own, perhaps you can also understand how imposing what you believe on everyone around you is completely inappropriate. For example, I’m a Christian from a faith that supports reproductive freedom for men and women. I have also used hormonal contraceptives in my lifetime, although I have since decided it’s not the best method for me. I have decided not to have children at this time, but not so that I can purchase that humongous SUV and plasma TV. In fact, I have found great satisfaction in my work for women’s health, involvement in my church and service to my community – hardly the road to wealth and fame. I don’t think I fit your one-dimensional portrait of a “modern” woman who wants to control everything in her life, but I do use birth control myself, and support the rights of others to use the pill, or the IUD, or “not tonight dear” or whatever other creative method a woman feels works best!

    My point is, not everyone shares your beliefs, your economic means, your health, your relationships or your life goals and successes. We’re all different. Perhaps if you could put yourself in other circumstances, you might see how others might need access to honest health care advice, based on science not on a particular religious or political viewpoint. In a country that prides itself on its freedoms, such a regulation as those would impose the beliefs of a few on the needs of many.

  • invalid-0

    Are we still talking about health insurance?

    We buy health insurance (pooled risk) to cover us in case we get sick.

  • invalid-0

    What am I imposing? I am just saying that we should not have to help you exercise the control you desire. I’m saying that you should exercise your own control. You can pay for your own control and don’t whine and demand forceful legislation when others don’t share your tolerance for or wish participate in certain methods. Because then YOU are the one imposing your beliefs on others. Freedom–remember?

  • invalid-0

    You can make that argument about many medical conditions. For instance, lets look at kidney diabetes transplantation. Imagine you’re a 50-something year old, with diabetes caused by long term obesity. Predictably, your kidneys fail. You’re going to want treatment to control this, right? It will be either dialysis or transplantation, both of which are expensive and in short supply.

    If we follow your argument about others being required to pay for your control, society and the medical establishment should be allowed to refuse treatment. Why? You made the life-style decision to eat too much and not exercise. Don’t force others who “don’t share your tolerance” (your words) to make up for your mistakes.

    I think we can all agree that this is an argument that will never fly, with good reason. But taken to the extreme, all healthcare and funding decisions are going to be disagreed with by somebody. (Similarly to AnonyMouse’s point about not wanting to pay for a war that he/she disagreed with.) Just as we are all required to pay for defense policies we don’t agree with, we as a society need to treat health care the same way.

  • invalid-0

    Dr. Dredd,

    If we follow your argument, then groceries, cooks, and trainers should be provided for people so they can avoid dialysis and transplantation. Mandating contraceptive support doesn’t even make it to that level, since lack of contraception doesn’t result in an unhealthy condition (unless feeling out of control qualifies). As Dr. Anne Davis points out, she is in favor of forcing health professionals to act against their consciences so that people can “continue working, going to school, and raising the children they already have”–not to save them from a life-threatening condition.

    By the way, where did I say anyone should be refused “treatment”?

  • invalid-0

    You said someone should be refused treatment when you advocated allowing pharmacists to refuse to dispense hormonal contraception, allowing physicians to refuse to write the prescriptions, etc.

    News flash. The Pill has other uses besides preventing pregnancy. The treatment of endometriosis and polycystic ovary syndrome comes to mind. Do you seriously mean to tell me that a pro-life pharmacist is going to ask every woman why she has a prescription for the Pill and dispense it if the reason isn’t contraception? More likely, that pharmacist will just refuse the Pill to everyone with a prescription. Ergo, refusing treatment. (And yes, lack of contraceptive support is resulting in an “unhealthy condition.”)

    Back to my dialysis analogy. Cooks, trainers, etc. do not require a doctor’s prescription to access. Everyone is free to hire them if they want to. The Pill, on the other hand, is prescription-only. A doctor/nurse practitioner/physician’s assistant has a monopoly on prescribing, and a pharmacist has a monopoly on distribution.

  • invalid-0

    Contraception = possible prevention of conception (not treatment)

    Drug sometimes called “birth control pill” used to treat endometriosis = treatment

    Healthy diet/exercise = prevention

    Dialysis = treatment

    Pregnancy = healthy, normal condition

    Complication of pregnancy = needs treatment

    No doctor, NP or pharmacist has a monopoly on prescribing/distribution.

    Developed countries = free market economy = patronize whichever health professional you choose = if no one wants to go to a certain health professional = out-of-luck professional

    I hope you are not actually a doctor.

  • invalid-0

    Let’s go over this again, shall we?

    Contraception = possible prevention of conception (not treatment)

    Drug sometimes called “birth control pill” used to treat endometriosis = treatment

    SAME DRUG! EXACT SAME DRUG! Like I said before, is a hypothetical pro-life pharmacist going to ask each and every woman who comes in with a prescription why she’s taking it? If not, and there’s a blanket denial, some women are going to be denied treatment.

    Furthermore, the distinction between prevention and treatment isn’t as clear-cut as you make it out to be. Look at Alzheimer’s disease and other dementias:

    Mild cognitive impairment = pre-dementia = try Aricept to improve cognition = treatment
    .
    Mild cognitive impairment = pre-dementia = try Aricept to improve cognition = prevention of disease progression

    By treating the cognitive impairment, you’re also delaying/hopefully preventing the progression of the dementia. So you’ve got prevention and treatment wrapped up in one!

    Going back to my original example of dialysis. Yes, it’s a treatment for failed kidneys. But there’s also evidence that dialysis prevents kidney function from getting any worse. In fact, after a period on dialysis, some people actually wind up regaining lost function and are able to stop. Again, treatment and prevention in one shot.
    .

    No doctor, NP or pharmacist has a monopoly on prescribing/distribution.

    Where are you going to get your medications, on the street?

    If you mean that no one particular physician/NP/pharmacist has a monopoly, that’s true to a point. In rural areas, however, you’re probably lucky to have one of each. So it becomes a de facto monopoly.
    .

    I hope you are not actually a doctor.

    Yes, dear, I am. And I enjoy doing it. And I don’t impose my values on anyone else.

    Hope YOU’RE not in the medical profession.

  • invalid-0

    1)Same drug, different use–pharmacists would understand the difference, therefore, no blanket denial as long as you make a little note on your prescription slip.

    2) We aren’t talking about Alzheimers.

    3) You would only fear de facto monopoly if your position is tenuous to begin with (meaning most medical professionals disagree with you) or if you simply believe you are smarter than most medical professionals (so since you are smarter, they must be forced).

    4) Conventional medical contraceptive advice currently is monopolized by the medicate/operate crowd. Ask any woman who has asked her OB at her 6-week postpartum checkup what he could recommend for someone who is morally opposed to birth regulation that separates the unitive and procreative aspects of intercourse. The response will either be a blank stare, or a condescending rant against her beliefs. Unless you are prepared to help such a woman, you are giving her biased medical care. Of course, it may simply be a bias of your incomplete training.

  • invalid-0

    1.)Same drug, different use–pharmacists would understand the difference, therefore, no blanket denial as long as you make a little note on your prescription slip.

    Really? Is the pharmacist really going to believe what is written? It would then be very easy for everyone to write PCOS on the script. I find it more likely that the pill won’t be dispensed to anyone.

    2) We aren’t talking about Alzheimers.

    Obviously. It’s called a paradigm.

    3) You would only fear de facto monopoly if your position is tenuous to begin with (meaning most medical professionals disagree with you) or if you simply believe you are smarter than most medical professionals (so since you are smarter, they must be forced).

    What? I was simply trying to reply to your argument several posts ago that we should pay for personal trainers for overweight diabetics if we pay for birth control pills, since both are life-style choices. My response was that, unlike birth control pills, personal trainers do not require a prescription. A person can go hire one at any time, if they want. Birth control pills, on the other hand, do require a prescription. The medical profession (doctor, nurse, pharmacist, whatever) controls access. Don’t know how we went from there to me forcing people to do thinks because I think I’m smarter.

    Conventional medical contraceptive advice currently is monopolized by the medicate/operate crowd. Ask any woman who has asked her OB at her 6-week postpartum checkup what he could recommend for someone who is morally opposed to birth regulation that separates the unitive and procreative aspects of intercourse. The response will either be a blank stare, or a condescending rant against her beliefs. Unless you are prepared to help such a woman, you are giving her biased medical care.

    Now you’re using the term monopoly the way I meant. Yes, the medical crowd controls access. That’s why it becomes so devastating when one of them decides that he/she is going to make moral decisions for everyone else.

    I’d be perfectly happy if birth control pills were over the counter.

    I’m sure there are ob/gyns out there who are opposed to birth regulation in the way that you state. (Remember W. David Hager? He was the guy who Bush wanted to appoint to the Plan B over-the-counter task force. He’s very religiously oriented.) If you don’t like your current doctor, go to someone else.

    Of course, it may simply be a bias of your incomplete training.

    Yeah, whatever.

  • invalid-0

    by this logic, we should really just lock up all women once their hit puberty to protect “life.”

    caffeine can cause miscarriage, does that mean that a person at a gas station can refuse to sell me a soda because i “might” be pregnant and a soda could harm that pregnacy?

    exercise can also do the same, does that mean that i can be denied a gym membership because i “might” be pregnant?

    the reason i say “might” is because we have no way to detect conception. this magic time that pro-lifers like to refer to when life supposedly starts. a woman’s own body doesn’t even recognize this point.

    if conception is the beginning of life, then all women who are sexually active are “pregnant” whether they know it or not and the government can do whatever it feels like to protect the “life” inside her, which we have no way of proving even exists. this is just insane to me!

  • invalid-0

    Tatyana,

    The logic would be to avoid direct or likely assaults on human life.

    How amusing to equate a soda or a gym membership with a device or drug which was constructed for the purpose of ending a pregnancy.

    Also amusing to assume that all sexually women are pregnant. Tell that to women who suffer from infertility.

  • invalid-0

    “If you don’t like your current doctor, go to someone else.”

    EXACTLY!!! If you don’t like the attitude of your doctor or pharmacist, GO SOMEWHERE ELSE!

  • invalid-0

    You’re right in that respect. However, both of us are assuming that there’s someone else to go to. What if we lived in a very rural community? From your comments, it sounds like you don’t want to be forced to go to someone who doesn’t accomodate your beliefs any more than I do.

    So what would you suggest we do in such a situation?