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Protecting health workers' beliefs

Federal funding would be conditioned on providers' right to refuse to perform tasks that they objected to.

August 22, 2008|Rob Stein | Washington Post

WASHINGTON — The Bush administration Thursday announced plans to implement a controversial regulation designed to protect antiabortion healthcare workers from being required to deliver services against their personal beliefs.

The rule empowers federal health officials to pull funding from more than 584,000 hospitals, clinics, health plans, doctors' offices and other entities that do not accommodate employees who refuse to participate in care they find objectionable on personal, moral or religious grounds.

"People should not be forced to say or do things they believe are morally wrong," Health and Human Services Secretary Mike Leavitt said. "Healthcare workers should not be forced to provide services that violate their own conscience."

The proposed regulation, which could go into effect after a 30-day comment period, was welcomed by conservative groups, abortion opponents and others, who said the measure was necessary to safeguard workers from being penalized.

Critics including women's health advocates, family planning advocates and abortion rights activists said that the regulation could create sweeping obstacles to family planning, end-of-life care and possibly a wide range of scientific research as well as to abortion.

"It's breathtaking," said Robyn Shapiro, a bioethicist and lawyer at the Medical College of Wisconsin. "The impact could be enormous."

The regulation drops a draft version's most controversial language, which would have explicitly defined an abortion for the first time in a federal law or regulation as anything that interfered with a fertilized egg after conception.

But both supporters and critics said the proposed regulation remained broad enough to protect pharmacists, doctors, nurses and others from having to provide birth control pills, Plan B emergency contraception and other forms of contraception. And both groups said the regulation would explicitly allow workers to withhold information about such services and refuse to refer patients elsewhere.

Leavitt said he requested the new regulation after becoming alarmed by reports that healthcare workers were being pressured to take actions they considered immoral. He cited moves by two doctor organizations that he said might require antiabortion doctors to refer patients to abortion providers.

An early draft of the regulation that leaked in July triggered criticism from women's health activists, family planning advocates, members of Congress and others who feared that the definition of abortion could be interpreted to include many common forms of contraception.

"Words in that draft led some to misconstrue the department's intent," Leavitt said in a telephone news conference Thursday. "This regulation . . . is consistent with my intent to focus squarely on the issue of conscience rights. This specifically goes to the issue of abortion and conscience."

When pressed about whether the regulation would protect workers who considered birth control pills, Plan B and other forms of contraception to be abortion, Leavitt said: "This regulation does not seek to resolve any ambiguity in that area. It focuses on abortion and focuses on physicians' conscience in relation to that."

David Stevens of the Catholic Medical Assn. said: "I think this provides broad application not just to abortion and sterilization but any other type of morally objectionable procedure and research activity. We think it's badly needed. Our members are facing discrimination every day, and as we get into human cloning and all sorts of possibilities it's going to become even more important."

The regulation, which would cost more than $44 million to implement, is aimed at enforcing several federal laws that have been on the books since the 1970s, aimed primarily at protecting doctors and nurses who did not want to perform abortions in the wake of the Supreme Court's Roe vs. Wade decision, Leavitt said.

But critics said they remained alarmed at the scope of the regulation, which could apply to a wide range of healthcare workers -- even those who, for example, were responsible for cleaning instruments used in an abortion.

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