Conscience can now be guide for reproductive health workers

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An 11th-hour rule from the U.S. Department of Health and Human Services is stirring national controversy by allowing people who provide reproductive health services to refuse information or procedures that violate their conscience.

Under the so-called "conscience rule," scheduled to take effect Jan. 19, any health care provider can refuse to disclose information or provide services to clients without disclosing such actions to supervisors, even if the individual's actions counter the mission of the organization in charge. The rule is backed by some religious and anti-abortion organizations including the National Catholic Bioethics Center.

"The proposed regulations will reinforce and reaffirm existing federal laws which prohibit recipients of certain federal funds from coercing individuals in the health care field into participating in actions they find religiously or morally objectionable," said John M. Haas, president of the National Catholic Bioethics Center in Philadelphia. "If you do not believe in performing an abortion, you want to be protected from being forced to do that. Others may disagree with us, but we are not forcing them to violate their conscience."

A spokesperson for Health and Human Services could not be reached for comment, but HHS Secretary Mike Leavitt said doctors and other health care providers should not be forced "to choose between good professional standing and violating their conscience."

"This rule protects the right of medical providers to care for their patients in accord with their conscience," he said.

But the state Department of Health, Planned Parenthood, Adagio Health and National Women's Law Center, among others, are reacting with fervor against the new rule.

They say women seeking assistance and care should be informed of all legal options available to them, be it emergency contraception, giving birth or choosing adoption or abortion.

"We believe women should be given accurate medical information that's nondirective so they can make their own decisions about their own reproductive health care," said Kimberlee Evert, chief executive officer of Planned Parenthood of Western Pennsylvania.

"This regulation essentially allows the provider to determine what information is given to the person," she said. "The provider can deny information and services to their clients without their knowing it is being denied."

Despite 200,000 comments opposing the action, HHS issued the new rule Dec. 18. It will take effect the day before President-elect Barack Obama takes office. Those supporting the new rule expect a battle with the Obama administration over its implementation.

Rules already are in place to protect any person, doctor or pharmacist from going against their conscience by providing abortion or contraception information or services to patients or clients. But current practice requires people to inform people that other options are available elsewhere.

The new rule also is drawing criticism for vagueness by refusing to define the term "abortion," which allows interpretations to include contraception. Opponents of the rule say it could bring chaos to organizations receiving federal funding to provide reproductive services for women.

"We're required to provide full and comprehensive information to anyone who wants information," said Richard Baird, president and chief executive officer for Adagio Health, a family-planning organization that provides services in 23 counties in Western Pennsylvania. Although Adagio provides information on all legal reproductive services, it doesn't provide abortions.

Current regulations, however, require it to provide full information to all clients: "It's clear cut, so when this rule is imposed, it will become confusing," he said.

As written, the rule also would protect health care providers opposed to vaccinations or other medical procedures, he said.

"This is a very detrimental regulation from the public-health perspective," Mr. Baird said. "I think it's a parting shot from the Bush administration to thank its supporters."

The rule generally divides the nation along the lines of abortion rights and anti-abortion forces.

Mike McMonagle, president of Pro-Life Coalition of Pennsylvania, said the rule was instituted not as a last-ditch gift to supporters of the Bush administration but because medical organizations were threatening to revoke the licenses of obstetricians and gynecologists who refused to provide abortions or refer patients to others willing to provide abortions.

"Pro-lifers didn't pick this battle," Mr. McMonagle said.


David Templeton can be reached at dtempleton@post-gazette.com or 412-263-1578.


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