Public Comments On Patient Rights vs. Provider Conscience

As we’ve been reporting and encouraging action on for a few weeks, the Department of Health and Human Services leaked proposal to create regulations that mimic two federal amendments – the Church and Weldon Amendments – that allow health care providers (both individuals and institutions) that receive federal grants to "opt out" of care that they reject to on religious or moral grounds, even to the detriment of a patient’s health, is now in a period of public comment. 

For a reminder, these proposed regulations (PDF) seem to have arisen from a declaration on Secretary Leavitt’s part that an overwhelming number of physicians are being coerced into providing health care services, most notably abortion (and, yet, oddly sterilization is mentioned as well – last time I checked it was women who were being coerced into sterilization procedures?), to which they object.

Despite the fact that said providers are already covered under federal amendments, and despite the fact that no one has unearthed evidence that proves providers are being forced to provide abortions under duress, Secretary Leavitt has deemed this such a crucial issue that public health regulations be pushed through just months before the Bush administration’s final good-bye. 

To make matters worse, the proposed regulations allow health care providers to opt out of any service they may find objectionable – even contraceptive and family planning services. This kind of a regulation would have a very real, extremely severe impact on women’s lives.  98% of women will use birth control at some point in their lives.

As Jessica Arons writes, health care providers may, "…be able to deny women access
to oral contraceptives, emergency contraception, and the IUD, among
other commonly used methods of birth control." 

One of the most troubling sections of the regulation document notes that:

Entities to whom this subsection 88.4(d) applies shall
not require any individual to perform or assist in the performance of
any part of a health service program or research activity funded by the Department if such service or activity would be contrary to his religious beliefs or moral convictions. 

The ACLU has been encouraging public comment on this since commenting officially began (see their call-to-action on the RH Reality Check homepage). Louise Melling, head of the ACLU, posted on Shakesville today with a reminder that there are only 13 days left if you want to register your comment on the HHS web site.

Rachel Walden, at Women’s Health News, reports that there are over 1100 comments posted so far. Including this one:

I strongly oppose and urge you to abandon the Provider Conscience Regulation. As written, the proposed regulations could allow institutions and individuals to refuse to provide needed care based on religious beliefs. These rules could significantly undermine the ability of American women to access contraceptive services and deprive them of the right to make their own informed health care decisions.

This kind of a regulation offers absolutely no protection for women who seek very real and needed reproductive and sexual health care. Secretary Leavitt has not been able to sufficiently explain to Americans why the proposed regulation offers no balance between the rights of women to access necessary health care services from providers and the rights of providers not to perform a procedure or prescribe medication they oppose. 

Comment now!

Like this story? Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

For more information or to schedule an interview with contact

  • invalid-0

    If a doctor had religious or moral problems providing contraceptives, they seriously have chosen the wrong profession.

  • invalid-0

    I am adamently opposed the proposed regulations that the Department of Health and Human Services released on August 21, 2008 expand existing law to allow more health care providers and institutions to refuse to provide needed care.

    Sensible regulation should weigh in the balance the risks and needs of both parties to any controversy. In this case the risks and thousands needs thousands patients are held hostage to a small group of people who have selected a profession whose conscience maybe be aggrieved. If they have
    problems fulfilling the requirements of their job then maybe they should have choose a different profession. The patience in need of medical services does not have the option of not requiring the services.

    For years, federal law has carefully balanced protections for individual religious liberty and patients’ access to reproductive health care. The proposed regulations appear to take patients’ health needs out of the equation. I urge you to restore this important balance and protect access to basic care for the millions of Americans who depend on federally funded health care services.

  • invalid-0

    There are still many people and companies that will take care of your needs. Not everyone in this country has religious convections. You still have the ability to get an abortion and birth control. Maybe not from the professional you were. Just as you want the freedom to get what you want where ever you want I want to be able to say no I can’t do that. I know who I have to answer to when I die. I have to be able to get up in the morning and feel good about what I doing. If you try to take these freedoms from me I won’t work in that field. Medical profession isn’t like a job at McDonalds we went to college some many year to take the position. I think as an American I have the freedom to choose what procedures I will do or not do.You want your freedom why are you trying to take ours away?

  • invalid-0

    “If you try to take these freedoms from me I won’t work in that field. Medical profession isn’t like a job at McDonalds we went to college some many year to take the position.”

    It’s pretty obvious from your semi-literate post that you most certainly have not completed college, Tim. Why lie and be so obvious about it?
    That said, any medical professional who refuses to prescribe contraceptives and any pharmacist who refuses to fill a legal prescription is not behaving in a professional or responsible manner and should has his or her license pulled.

  • invalid-0

    the ‘rights’ of women who have a voice and ability to do something already over right the ‘rights’ of the weak and helpless unborn potential for individual life of the basic human right and US constitutional life to LIFE, and of course the right to liberty and the pursuit of happiness. we were ALL without a voice and ‘potential life’ at some point and considering a baby has to have a heartbeat in order for the mother to ‘safely’ abort (i have never heard anyone say they felt ‘safe’ during an abortion) a life IS being snuffed out in usa against its constitutional rights. its worse when it happens by having the baby mostly born until only its head is inside and sucking its brains out while it is still alive just to loophole the definition of ‘born’ mr sandra day oconner decided she/he could unprecedentedly decide. (and obama specifically supports this medieval murder calling this type of murder constitutional no matter how much he covers it up with his flowery speech CHARM IS DECEITFUL remember to all the choicers who call themselves christians and murder is sin)

    every health care worker has the same freedom to their rights as choicers who are constantly slammed with propoganda and lies by planned parenthood who makes BILLIONS off of lying to you. GO TO ANOTHER FREAKING PROVIDER WHO HAS NO CARE about BASIC HUMAN RIGHTS like YOU DOnt…don’t force YOUR beliefs ON US!!! hello!!! quit whining about pro lifers trying to take your rights when your rights over ride OUR rights to choose not to assist you in life issues–and when your rights override and snuff out the rights of weak individuals with no voice to even life in the first place.

    pro life is a HUMAN RIGHTS issue rather than a religious one. I suggest to everyone that they look up fetal development online and find out about ALL their options before going to an abortion clinic because ironically to their banner of ‘choice’ they only offer ONE at their clinic and that ONE brings death to your child and money in their pockets

    thanks and good day

  • invalid-0

    If you have a problem with contraceptives than, when and if you graduate from HS and enter college you really need to find a job in some other profession than one which requires you to fill prescriptions for them.

  • invalid-0

    How do you assume she’s in high school?

  • invalid-0

    I believe the fairest way to resolve this particular issue would be to create a new professional notch in the healthcare industry “Reproductive Specialist.” This would ease a great strain on a already seemingly overburdened healthcare sysytem.

    • invalid-0

      How on Earth would that ease the strain on the health care system? If anything, adding yet another player will make things even more complicated.

      We already have “Reproductive Specialists.” They’re called ob/gyn’s (women) and urologists (men).

  • invalid-0

    This regulation was drafted to reinforce laws that ALREADY EXIST to protect people’s rights to CHOOSE to live according to their deeply held beliefs.

    The regulation would not be necessary if discrimination were not rampant in medical schools and residency programs that blackball anyone who brings up the slightest resistance to anything having to do with abortion.

    If you demand that I do something with my body that I am morally opposed to doing, you are forcing your beliefs on me and that is very intolerant of you.

  • invalid-0

    Why does it bother you so much that a person has the ability to say no I won’t do that? Not every person in the medial field has convictions. So why should the ones that do have these convictions have to do what they feel is wrong. It is not an easy job. They do things everyday that no one could pay alot of you to do. Is it that the ones that believe this to be wrong you are trying to push to believe it is ok? Or is it convience to you? No matter where you go you want to be able to have these procedures done and get the pills and contraceptions you want? There has to be a reason other than your freedom is being taken away. That is not true. It is just not everyone will do what you want when you want. Put your self in my shoes and walk around for a while. I believe I am in this position for a reason. I am my religion. It makes me who I am. I have to get up and feel good about what I do everyday. I care for people like they are my family. I am sorry that you have to get so upset and say nasty things just because you don’t believe what I do and feel I am wrong.

  • invalid-0

    You don’t have the ‘right to choose’ for other people. We pay health care providers to provide health care, not lectures on what you call ‘morals’. Shall we have 7th day adventist nurses be able to refuse to perform blood draws and/or transfusions because their religion forbids it? Should Christian Scientist pharmacists be able to refuse to fill, say, a legal prescription for antibiotics and offer up a prayer instead? Most people and most employers would say that religious fanatics such as yourself should find an occupation where the most basic professional duties don’t interfere with your precious consciences or, to put it another way, try to find a profession where you don’t have to deal with a woman’s need for basic health care or, preferably, where you don’t have to deal with any women at all.

  • invalid-0

    Pro-choice. Does that mean that you can make the choice whether or not to have an abortion, but I can’t make the choice whether or not to participate in your abortion?

    I can’t understand why anyone would want to recieve health care from workers who were being coerced into doing it. It sounds like a recipe for mistakes and problems to me, not to mention morally questionable no matter what your views on abortion or birth control or sterlization are. I value my doctor’s judgement very highly, if I didn’t he wouldn’t be my doctor, and I would not want to be receiving treatment from any doctor or nurse or health care worker of any kind who was going against his or her own judgements and beliefs to give me what I want.

    I also would not want to receive treatment from any health care professionals who completely lacked any convictions. They don’t have to be the same convictions as mine, but the conviction that they were doing the best thing for me would be nice. I want to know that the people helping me are real people, not just programmed robots, AND that the people who want to help me are not being discriminated against based on religious or moral beliefs.

    I am a pre-med student, I am pro-life, and I am a woman. I want to go into health care because that’s what interests me, I want to help people, and it plays on my strengths. I volunteer on an ambulance and I am good at what I do. So no, I do not feel I should seek out a different profession just because of the slight chance that I might one day have an otherwise healthy patient who wants me to give her an abortion, or I might one day be asked to assist in an abortion in some way. Not participating in that one procedure would not make me any less effective in any other area of my practice, and participating in it against my will could have a detrimental effect on the rest of my practice, leading to poorer quality care for my other patients as a result of my internal struggle and stress.

    I’m not pro-choice, but I respect other people’s right to be. Can’t they respect my right not to be? Or at least, stand by what they claim to care about most, the right to make significant choices in one’s own life and have the protection of law while doing it?

  • invalid-0

    I am a 7th day Adventist nurse and neither I nor anyone I know has a problem doing blood draws or giving transfusions. Perhaps you need to do a little more research.

  • invalid-0

    Look, not every woman hasa choice when it comes to which doctors or pharmacies she can use. What about her rights to choose birth control?

    Not every woman lives within an easy distance of a town that has one clinic, much less a town that has two or more. What are her choices, should the one pharmacy in town decide that they just can’t fill her birth control prescription anymore?

    Not every woman can afford to take more than one day off of work to go to a physician and get her prescription filled, and it’s not like those who exercise the “conscience clause” advertise it to likely patients. Sure, she’ll know for next time that she can’t go to that doctor or that pharmacy, but what happens to her in the intervening time before she can afford to take another afternoon off work?

    HMO’s and health insurance also strip away consumer choice from women. If the only doctor or pharmacy in town that a woman’s insurance covers refuses to provide her with birth control, what are her options? What if she cannot afford to see someone outside her network? Where are her rights?

    Given that the HHS regulation wording is so vague that any treatment can be withheld from any patient based on the provider’s “conscience,” I’m guess you’d be pretty angry if the Scientologist at the pharmacy wouldn’t fill your kid’s Ritalin prescription, because her religion doesn’t believe in psychiatry. You’d be angry if the Muslim ambulance driver refused to transport you to a hospital because you were drunk, and the consumption of alcohol is a sin to him. You’d be angry (and possibly dead) if a Jehovah’s Witness doctor refused to give you a blood transfusion, because of his religious beliefs.

    The point is, patients have a right to care. If you want conscience clauses, you have to build in some form of patient protection that doesn’t rely on “Go Elsewhere,” since that isn’t an option for many patients.

    For example, I’d be amenable to a pharmacist conscience clause that requires every pharmacy to have in the building during operating hours at least one pharmacist willing to fill all prescriptions. Sure, Pharmacist 1 can abide by his conscience and refuse to fill the Viagra prescription for a man using it to cheat on his wife. But,the pharmacy must have Pharmacist 2 in the building to fill it for the adulterer, since the adulterer also has the right to have his prescription filled.

    Too long, but you get the point, I hope.

  • invalid-0

    First, I’m so pleased that SDAs no longer have a issues with blood transfusions. I’m curious though, when I speak to the 2 or three 7th Day Adventists I know they tell me that transfusions are still forbidden to them as do numerous references on the ‘net.
    That said, my example was one of many about what very well COULD happen if idiosyncratic belief systems were allowed to dictate and interfere with patient care in the name of ‘conscience’ not what DOES happen.

  • invalid-0

    Great post.

    To add to what you said, I think pharmacies that are going to cherry pick which prescriptions they’re going to fill should have to post a very visible sign on the front door and the pharmacist should have to wear an armband or something so that I, as a customer/patient, know ahead of time whether or not I wish to take a chance on getting my prescription filled there.

    My teenage daughter takes birth control pills for a hormone imbalance and it’s unthinkable that she might have to bear the humiliation of having a pharmacist announce out loud in front of other customers that she’s a sinner and that having interaction with such a sinner is against his religious beliefs. Which, in essence, is what they’re saying.

    If this bill was just about abortion, it would be restricted to just abortion. It isn’t. It covers anyone and is so vaguely worded that the cook at the hospital could refuse to prepare anything other than fish on Fridays.

    Crazy is the only word for what’s happening in this country.

  • invalid-0

    That is what the internet is for. Buy prescriptions online. Call the Dr. before wasting your day to make sure they are going to do what you need done. If not ask who does. This all comes down to convience. So, make it easier for you. Don’t waste your time. Use the resources around you. Pharmacist don’t blurt out what prescriptions you are taking. Usually they ask if you have taken it before and if you have any questions. They are not going to get down on they knees and starting praying infront of you because you are taking birth control.

    • invalid-0

      They are not going to get down on they knees and starting praying infront of you because you are taking birth control.

      No, what they’re apt to do is sometimes pocket the prescription and always publicly lecture the individual trying to fill the prescription. The notion that a pharmacist willing to behave unprofessionally enough to refuse to fill a legitimate prescription would be otherwise discrete and professional is as nonsensical as your idea that a woman should have to have a computer, an online account and a credit card in order to obtain birth control pills.

      The onus should not be on the consumer trying to fill a legitimate Dr’s prescription. Those willing to behave in a manner this unprofessional and insulting have no business being licensed as pharmacists.

  • invalid-0

    I’ve been reading quite a few posts about abortion rights, women rights and sarah palin and they seem to be going together better and it seems palin is in stark contrast from actually advancing women’s rights.

  • invalid-0

    Hello there!

    I have to say that if a doctor has problems giving out condoms or another type of contraceptive maybe you should’ve gone for a priest instead of a being a doctor. If you are a doctor you should abide by the rules of science and proven results, and not be wasting your time on your own thoughts while you can solve someone else’s problem or life. When a patient needs a doctor he needs his help quickly and in the best way possible, doctors should act on what they learned in med school and not on what they heard in church.

  • invalid-0

    I agree. Doctors are scientists and should be doing everything in their power to help people heal as well as stay away from health problems in the future. It is important that doctors keep an open mind in situations like the ones described above. Especially when it comes to contraception and the younger generation.