Bush's Last-Minute 'Conscience' Rules Cause Furor

Health and Human Services Secretary Michael Leavitt said he felt compelled to issue the new rules after what he called an unsatisfactory exchange last year with groups representing obstetricians and gynecologists over new ethics guidelines. (Getty Images)

Health care workers, hospitals and even entire insurance companies could decline to perform, refer or pay for abortion or any other health care practice that violates a "religious belief or moral conviction" under new rules issued by the outgoing Bush administration.

"This rule protects the right of medical providers to care for their patients in accord with their conscience," said Health and Human Services Secretary Michael Leavitt.

But opponents of the rule, now set to take effect Jan. 19, say it could threaten patients' health. "This is a very wide, broadly written regulation that upsets what has been a carefully established balance between respecting the religious views of providers, while also making sure that we're guaranteeing patients access to health care," said Cecile Richards, president of the Planned Parenthood Federation of America.

For example, Richards said, many states currently have laws requiring that rape victims treated in hospital emergency rooms be offered the option of taking emergency contraceptive pills to prevent pregnancy. But she said that because providers who don't believe in emergency contraception could now simply opt not to tell women about that option, "under this rule, we believe that in fact now women who are the victim of sexual assault either would not be guaranteed either information or health care access to emergency contraception."

That slap at state laws spurred opposition from more than a dozen state attorneys general when the regulations were first proposed. Connecticut Attorney General Richard Blumenthal says he'll fight to see the new rule rescinded.

"This rule is an appalling insult and abuse — a midnight power grab to deny access to health care services and information, including even to victims of rape," Blumenthal said.

But Leavitt said he felt compelled to issue the new rules after what he termed an unsatisfactory exchange last year with the organizations that represent the nation's obstetricians and gynecologists over a new set of ethics guidelines.

"It came about primarily because some of the professional association were trying to define as competence a willingness to perform abortion. And I think that's wrong," Leavitt said in September. "A person can be perfectly competent and feel it's not morally correct to perform an abortion. And they ought to have the capacity to be protected in that right."

That ethics policy, however, from the American College of Obstetricians and Gynecologists, had less to do with whether doctors should be willing to perform abortions or other potentially controversial services, and more to do with what they should do if they were unwilling to perform them. In those cases, according to the policy, doctors should tell patients upfront and refer them to someone who is willing to provide the services.

Under the new regulations, however, such referrals will not be required. That pleases groups like the Family Research Council. "What these conscience regulations do is let the individual decide what their conscience is, and not the federal government, be it Barack Obama or George Bush," said Tom McClusky, the group's vice president of government affairs.

But Barack Obama made it clear during the presidential campaign that he disapproved of the rules. The president-elect said an early version of the regulations "raises troubling issues about access to basic health care for women, particularly access to contraceptives."

While the incoming president can't simply wipe out the rules with the stroke of a pen, there is a relatively abbreviated process for taking them off the books. It's called the Congressional Review Act. And because the Bush administration issued the regulation late in the current president's term, the new Congress will have 75 legislative days to pass a "motion of disapproval." All it takes is a simple majority of votes by the House and Senate, and the motion is not subject to delaying tactics in the Senate.

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From NPR News, this is All Things Considered. I'm Robert Siegel.


And I'm Melissa Block. The Bush administration issued a new and controversial rule today. It allows health care workers, hospitals, and even insurance companies to decline to provide services that violate their moral or religious beliefs. Opponents say the rule is so broad it could threaten patient care, as NPR's Julie Rovner reports.

JULIE ROVNER: This fight, like so many others in health care, started over abortion. For decades, federal law has protected doctors and other health care workers from being required to perform or participate in abortions if it violates their conscience. But outgoing Health and Human Services Secretary Mike Leavitt says he wanted to add the regulation to clarify those laws. His actions came after a spat last year with the group that represents the nation's obstetricians and gynecologists over a new ethics policy. As Leavitt explained in September...

Secretary MIKE LEAVITT (Department of Health And Human Services): It came about primarily because some professional associations were trying to define as competence a willingness to perform abortion, and I think that's wrong. A person can be perfectly competent and feel it's not morally correct to perform an abortion, and they ought to have the capacity to be protected in that right.

ROVNER: In fact, what the new OB/GYN policy focused on was not the willingness of doctors to perform abortions, or other controversial procedures. Rather, the policy said doctors who were unwilling to do such procedures should tell patients up-front and refer them to someone who will. Under the rules issued today, they don't have to do either. And the rules extend beyond doctors and abortion. For example, pharmacists can refuse to dispense birth control. Religious health insurance plans can refuse to cover in-vitro fertilization or sterilization. Cecile Richards is president of Planned Parenthood.

Ms. CECILE RICHARDS (President, Planned Parenthood Federation of America): In fact, I think the Bush administration has now opened the door to allow individuals, based on their own personal biases, to deny patients access to information and health care services.

ROVNER: One of the things that worries Planned Parenthood most about the new rules is that they supersede state laws, like ones that require rape victims to be offered emergency contraceptive pills. Roger Evans is the group's general counsel.

Mr. ROGER EVANS (National Litigation Director, Planned Parenthood Federation of America): A lot of states around the country where the policy that has been adopted is that victims of rape who show up in an emergency room have a right to be offered emergency contraception, the states are now going to be hamstrung in enforcing the laws.

ROVNER: Bush administration officials, however, say the rules don't change any laws. They simply make health care providers more aware of the laws that already exist. Joxel Garcia is the HHS assistant secretary of health. He's an OB/GYN and former health commissioner in Connecticut. Yet he says he didn't learn about the federal conscience laws until after he started working for the federal government.

Dr. JOXEL GARCIA (Assistant Secretary of Health, Department of Health and Human Services): Sometimes we are so into helping our patients that we don't even know what legal framework we have to protect ourselves.

ROVNER: The rules are said to take effect in 30 days, but they may not be in effect for long. Opponents, including lawmakers like Washington Democratic Senator Patty Murray, say they're already working on ways to rescind the rule.

Senator PATTY MURRAY (Democrat, Washington): We are not going to sit by and just let this occur. It may take us a while to undo something like this. But, you know, for the health care of women in this country, they should not have this slammed on them as this president walks out the door.

ROVNER: Because the rule is coming so late in the president's term, it's subject to something called the Congressional Review Act. That allows it to be cancelled be a simple majority vote of the House and Senate and signed by the new president. Julie Rovner, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

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