HHS Rule Out of Touch with Medical Reality

In the 127-page rule released yesterday, Health and Human Services Secretary Mike Leavitt paints a picture of discrimination and retribution in the medical world. He portrays this new regulation as a much-needed recourse for medical providers living in fear. He argues that too few doctors and nurses know that federal law already protects their jobs if they abstain from providing abortions or sterilizations based on their personal beliefs. He imagines that anti-choice physicians are forced by their pro-choice colleagues to stifle their objections rather than risking professional suicide by speaking up.

Secretary Leavitt outright refuses to offer any evidence to support these allegations; no one knows where this scenario plays out or how often. But I can say that it bears no relation to my experiences as an ob/gyn in New York City, nor does it match what my peers around the country tell me about their jobs and hospitals. 

And the hundreds of physicians who submitted public comments against the regulation did not share Secretary Leavitt’s view of their workplaces, either. In fact, many hospitals in the United States do not provide abortions at all, and they do not train their residents in pregnancy termination, either, not even to prepare them for emergencies.

If Secretary Leavitt had visited the hospital where I practice, he would have found that every employee knows their rights. Some will not assist women undergoing abortion. They step away from these procedures without penalty or censure. Indeed, their colleagues take on more work to protect their right to refuse.  

At my hospital, Secretary Leavitt would have met a few residents who opted out of the day in their rotation when I teach abortion procedures (the majority participate). He would have seen that this did not affect their grades, their recommendations, or any aspect of their future careers. 

Secretary Leavitt would have talked to the anesthesiologists on staff, some of whom prefer not to participate in abortions. He would have heard about the ways we balance the schedules to accommodate these physicians and their beliefs.  

In the bookkeeping office, Secretary Leavitt would have talked to a clerk who refuses to process state Medicaid forms for abortion patients — and another clerk who does this work for her. No harm done.

Even in medical crises, we honor employees’ consciences. I wish Secretary Leavitt had been at the hospital the day that my patient Melissa* started to hemorrhage.

Because she was 16 weeks pregnant and already ill, Melissa was in a bed on the labor and delivery floor. She began to bleed. Her only treatment option was abortion; she agreed to end her pregnancy. 

We could have moved her into the empty operating room across the hall for her dilation and evacuation (D&E) abortion. We did not. Instead, we put her on a gurney and took her, in pain and bleeding, on a 15-minute ride through the hospital’s labyrinthine corridors to another operating room.

Why not use the room seconds away from Melissa’s bed? Melissa’s nurse said, "I’m not going to help you with an abortion." She refused to be in the operating room, even though she would perform no part of the procedure herself. We had two surgeons at Melissa’s side ready to go, but still we moved Melissa to a part of the hospital staffed by a nurse who did not object to abortion.  

Melissa survived the balancing act between her health and her nurse’s beliefs. As they are written, the laws on medical workers’ consciences sometimes put us in tricky situations, but we follow them while keeping our patients healthy. Now Secretary Leavitt has put fresh obstacles between women and the treatments they need to stay well. His regulation expands the scope of current laws, extending refusal to many more medical services and letting healthcare employees withhold even information about patients’ options.  

Physicians like me understand that Secretary Leavitt’s rule is, at best, a waste of time and money for the 571,947 hospitals and other healthcare providers to which it applies. At worst, the regulation will cause real harm to women and families. 

We look to Tom Daschle, the incoming Secretary of Health and Human Services, and President-elect Obama to reverse Secretary Leavitt’s rule. None of us can afford the damage it will do, both to the practice of medicine and the lives of our patients.

*Her name has been changed.

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  • invalid-0

    Thanks for providing this real-life perspective.

  • invalid-0

    Frankly, I’d argue that you went above and beyond your responsibilities to “conscience” in the case of Melissa. If she was hemorrhaging and at risk of death, someone’s “conscience” should not be allowed to hinder saving a life.

  • invalid-0

    I agree, this procedure was above and beyond what should have been required. This patient could have died in the time it took to get her prepared and to an operating room across the hospital. In order to preserve the delicate sensibilities of a single nurse, (who should not have been there to begin with if she was morally abject to sometimes needed procedures performed in that area) a patient’s life was put at severe risk of harm or death. I certainly hope that at the very least someone explained to this woman afterward that her “morals” could have killed a woman going to a hospital expecting quality medical care, and instead she was treated as less valuable than the “morals” of this nurse, who chose to work in a field where she knew she would be expected to perform duties she may object to, and decided instead of going into a different field where there would be no need for a choice between her morals and the life of a patient, she chose to put how many patients at risk by refusing to provide the care that she was trained and hired for? If you can’t or won’t do a job, then you shouldn’t take the job to begin with. As a tech support worker, I would be fired or at the least disciplined for refusing to work with particular operating systems, computer brands, or individual customers, because this is the job I was hired to do. In the health care field, ability and willingness to do ones job is far more paramount. If I should refuse to do my job, a customer may simply have to go without internet service for a few more minutes while another technician is found, or until he or she can call another support line for assistance. In the medical field however, that refusal to do the job that a person is hired for can be the difference between a healing patient and a dead one. The possible ramifications of this are terrifying.