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In good conscience, conscience clause had to go

Submitted by on Saturday, 28 February 2009 No Comment

You really have to wonder what George W. Bush was thinking (pausing for uproarious laughter to end in 3 … 2 … 1 …) when he enacted the Provider Refusal Rule during his final hours in office.

He had to know the rule, which allows any worker in a health-care setting to refuse to provide patients information and services to which the worker is morally opposed, was headed for quick reversal under President Barack Obama.

Was it merely a nice parting gift from Obama? I knew a governor who lost a bitter re-election battle and proceeded to remove all the telephones from the executive offices his final day on the job. Maybe Bush could have just done that instead of approving a dangerous regulation simply to pander to the anti-abortion crowd.

Friday, Obama appeared to be poised to send back the “gift” by  opening a 30-day comment period after which the regulation could be rescinded.

It should be. It’s so needlessly broad that it could allow providers – or even janitors, who at times are pressed into service as translators in some hospitals and clinics – to refuse to discuss virtually anything from vaccinations to blood transfusions to life support. All three can be debated on moral grounds.

Let’s not kid ourselves, though. The regulation was aimed at abortion and contraception, even though the regulation is not limited to these areas.

Refusal clauses became popular in the United States shortly after Roe v. Wade made it clear that a woman has the right to an abortion. The first law, at the federal level in 1973, allowed providers to refuse to perform abortions or sterilization if they objected on moral grounds. The laws quickly spread to the state level.

As of this month, 43 states let providers refuse to perform abortions, 13 let them refuse to provide contraception and 17 allow opt-outs on sterilization, according to The Guttmacher Institute.

Those laws are reasonable, as long as the provider refers patients to someone who will provide the care if the patient is interested and as long as the patient isn’t delayed in getting care. That’s also in keeping with the American College of Obstetricians and Gynecologists’ ethical guidelines.

But to allow providers to refuse to even give information about a procedure on moral grounds is wrong and dangerous. New York University bioethicist Jacob Appel said it best when writing about a 2002 case that made it clear doctors can’t lie about treatment options – and lying by omission is no different than deception by commission.

“If only a small number of physicians intentionally or negligently withhold information from their patients significant damage is done to the medical profession as a whole” because “pregnant women will no longer know whether to trust their doctors,” Appel wrote.

Health-care workers should not be forced to participate directly in procedures that violate religious principles.

But patients shouldn’t have to wonder if they’re getting only half the medical story without even a pointer as to where they could get the rest of the information or treatment in time.

Copyright 2009 Debra Legg. All rights reserved.

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