Federal regulation expands medical professionals' options to refuse care that conflicts with their moral or religious beliefs
May 17, 2019 (ACP) – New federal policies that greatly expand the scope of federal health care conscience laws have raised concerns for the American College of Physicians, which believes the new policies potentially threaten the ability of many patients to get the care they need.
“We're concerned about access to care for patients, especially vulnerable populations and those in rural or underserved areas,” said Hilary Daniel, a senior health policy analyst with ACP. “There are countless scenarios in which patients could be refused care, and the policies do not provide any recourse for those patients.”
At issue is a federal rule that was released by the Trump administration in early May and will go into effect this summer. The rule encompasses conscience laws, which allow medical professionals to decline to provide care if they believe providing it would be contrary to their moral or religious beliefs.
“The rule consolidates the authority and enforcement of 25 of those laws under one agency and broadly expands the authority of the Office of Civil Rights to enforce those laws,” Daniel said. “These laws primarily focus on abortion but also include issues related to assisted suicide, advance directives and other medical care.”
In addition, according to a National Public Radio report, the new rule “allows health care workers who have a ‘religious or conscience’ objection to medications or medical procedures such as birth control or sterilization to refuse to participate in those procedures, even in a tangential way [and] this represents an expansion of existing protections.”
The rule affects a long list of health care workers and facilities, from hospitals and skilled nursing facilities to home health care workers, front desk staff, insurance companies, pharmacists, and more. There are also new policies regarding compliance with the conscience laws.
According to a report by Politico, President Trump touted the new policies, saying they will protect “physicians, pharmacists, nurses, teachers, students and faith-based charities.” He added that “together we are building a culture that cherishes the dignity and worth of human life.”
Others, however, have deep concerns about the policies.
“Make no mistake,” House Speaker Nancy Pelosi said in a statement, “this is an open license to discriminate against Americans who already face serious, systemic discrimination.” She also declared that “these bigoted rules are immoral, deeply discriminatory and downright deadly, greenlighting open discrimination in health care against LGBTQ Americans and directly threatening the well-being of millions.”
ACP's Ethics Manual provides guidance regarding health care conscience policies.
“Although the physician must address the patient's concerns, he or she is not required to violate fundamental personal values, standards of medical care or ethical practice, or the law. … If the physician cannot carry out the patient's wishes after seriously attempting to resolve differences, the physician should discuss with the patient his or her option to seek care from another physician.”
However, the manual adds that “a physician may not discriminate against a class or category of patients.”
ACP fears that the new policies will harm patients by expanding the refusal of care.
“For example, a receptionist at a pediatrician's office can refuse to make an appointment for the child of a same-sex couple because of the receptionist's personal beliefs,” Daniel said. “Another example would be a pharmacist or pharmacy tech who refuses to fill a prescription for birth control. A surgeon can refuse to perform a sex reassignment or gender confirmation surgery. A physician could refuse to prescribe pre-exposure prophylaxis (PrEP) medication.”
Legal objections are in the works. The city of San Francisco filed suit in federal court arguing that the rule is unconstitutional, Daniel said, and the attorney general of California is also expected to sue.
“We expect there will be a number of other legal challenges,” she said.
A copy of the new policy, “Protecting Statutory Conscience Rights in Health Care, “ is available on the website of the Department of Health and Human Services, as is a fact sheet on the new regulation prepared by the department.
Back to the May 17, 2019 issue of ACP Advocate