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.