The Onus Is on Women or How the HHS Rules Keep Women In The Dark


Give a listen to this fascinating interview on WTOP with a writer and blogger for which I have tremendous respect –  Deborah Kotz, a Senior Editor at US News & World Report. Kotz is interviewed on the recent passage of the "HHS rules" that allow for providers or any staff members at a health care institution receiving any kinds of federal funds to refuse to provide or participate in the provision of services which they find "objectionable."

Kotz says "at first blush it seems like a well-intentioned rule" but then does justice to the underlying issue here – that with this rule, women may very well be left in the dark as to just which legal, safe, medical options their providers do or do not have objections to, leaving female patients at a disadvantage. As Kotz says in the interview,

"This is definitely a rule that has a lot of people outraged really. Medical organizations like the AMA…say this will hurt patients…especially women patients…What these groups have pointed out is that the rules already exist that protect doctors from providing services they object to. Bush’s OMB [editor’s note: Office of Management and Budget] already says this rule would put an undue burden on hospitals and that the rules are duplicative…There is concern out there that…especially in terms of what a doctor has to disclose – there’s really nothing in the law that says that a doctor must tell a patient, ‘Hey, you know what, I really don’t believe in birth control, I’m not going to give you a prescription however there are other doctors who will…’"

Kotz goes on to state that she asked HHS whether the onus shouldn’t be on doctors to put forth their objections to their patients so that female patients know which services they will or won’t provide and "at least allow the patient to go elsewhere." 

It’s unclear whether the interviewer really understands what an injustice this truly is for women. In response he says, "For better or worse, I think this is something a lot of women have had to get used to – they’ve had to ask what kinds of services will you provide to me?" For better or worse? I’m going to go with "worse" here. 

How will this regulation play it in real-life circumstances? Kotz presents a hypothetical situation. A woman who is raped and is attended to by a physician or nurse who "does not believe in" using emergency contraception (EC) is under absolutely no obligation to tell the woman a) that EC is an effective way to prevent pregnancy after unintended or unwanted sexual intercourse or b) that he or she will not provide EC but will refer the patient to another provider or pharmacy that will provide the EC for her. This is not just an "onus",  it seems like out and out malpractice to me. If a male patient is assaulted and in need of a particular kind of health service and a physician does not provide, mention or refer for that service even if it could help improve his health outcome, wouldn’t it be incumbent upon the provider to do so? 

Clearly it’s more commonly thought of as an "inconvenience" for women – we just need to somehow know or make sure we find out which of our providers will impose their own moral judgements on our health and lives and which won’t. 

Kotz ends on a powerful note by stating that a doctor truly should have
an obligation to inform female patients of his or her moral objections
and ensure that women are referred elsewhere if need be. 

We’ve covered this rule extensively and will continue to do so over the coming days and weeks. This rule will certainly be challenged either Congressionally or via the rule-making process once President Elect Obama is sworn into office.

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  • pcwhite

    I have nothing intelligent to add to this article except to say what a horrible outcome this is.  What person can go to sleep at night knowing s/he wilfully deprived her/his patient of medical care?

  • invalid-0

    This is truly and sadly depressing. It was hard for me to believe that HHS actually took this from Bush. He really has no respect for women; to think he has a wife and daughter! I wonder just what they say. This does not apply to just birth control but vast loads of compromising situations in which a doctor’s beliefs can now hinder health care. I’m not saying that I dont trust the doctor or the patient, but it is a new road for miscommunication, which will lead to disaster for certain people. I mean there are already so many malpractice suits over “You didnt tell me these effects or this option, etc.” HHS just took away the basic and necessary ideas in the healthcare system: the right to choose and the right to be informed. And this is for everybody!

    Hopefully, the Supreme Court or new legislature will have something to say about this. I don’t think people in general will like this (even some conservatives), because effects will start to trickle down into groups of different beliefs.

  • invalid-0

    The most frightening part of this is not just that we’re looking at millions of women being denied reproductive care based on the belief systems of others, but what about other services? What about someone of a religion that does not believe in the use of blood and blood products faced with a patient in need of a transfusion? Is this person allowed to deny this patient a life saving procedure based on morals and allow the patient to die, when the treatment may in fact be very much wanted by that patient and their family? What about doctor’s assisting a failed suicide? Should their morals dictate that suicide is wrong and should be punished, does that allow them to deny treatment, and allow a patient who otherwise may have survived to die anyway based on their beliefs?
    This rule was put in place to keep women as second class citizens, and to deny them adequate reproductive health care, but there are so many other possible repercussions that are just as bad if not worse in the end.