Imagine a lifeguard at a public
beach who sees a swimmer caught in a riptide but feels he cannot rescue
her because his faith prohibits contact between the sexes. He calls
for his partner who does not share his beliefs, and the woman is saved.
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
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.