Medical conscience and Obama

[Niles]

Obama Favors Strong 'Right to Refuse' Protections for Health-Care Workers
President Voices Support for 'Conscience Clauses' Ahead of Plans to Scale Back Bush-Era Policies
By Jacqueline L. Salmon
Washington Post Staff Writer
Thursday, July 2, 2009 2:25 PM

President Barack Obama said today that he still favors a "robust" federal policy protecting health-care workers who have moral objections to performing some procedures, even though he plans to roll back a Bush administration rule that expanded such protection.

Speaking to eight religion reporters at the White House before his first meeting with Pope Benedict XVI on July 10, Obama sought to reassure Catholic health-care workers that they would not be forced to perform abortions. Obama said he is a "believer in conscience clauses" and that a new policy would "certainly not be weaker" than what existed before Bush expanded it late in his administration.

Shortly after taking office, Obama announced plans to roll back the Bush policy, which would have cut off federal funding for thousands of state and local governments, hospitals, health plans, clinics and other entities if they do not accommodate doctors, nurses, pharmacists or other employees who refuse to participate in care they feel violates their personal, moral or religious beliefs.

But Obama's plans have lead to fears among Catholic doctors and other health care providers that they would be forced to perform abortions, sterilizations and other procedures that violate Catholic teachings, despite federal laws protecting their right to refuse to perform such procedures.

The Health and Human Services Department is reviewing hundreds of thousands of public comments it received in response to the Obama administration's Feb. 27 announcement it planned to rescind the Bush rule.

Obama's trip to the Vatican will coincide with his participation in the Group of Eight summit, a meeting of leaders of the world's richest nations, July 8-10.

Obama said he hopes to come out of the meeting with the pope with an agreement to cooperate in several areas including Mideast peace, poverty, climate change, immigration and other issues in which he said that Benedict has shown "extraordinary leadership,"

But, he added in the 45-minute session in the Roosevelt Room, while the two have areas of "deep agreement . . . there are areas of some disagreement." Those areas include abortion rights and embryonic stem cell research, which Obama supports but Catholics say violate their moral teachings.

The American Catholic church has been riven with conflict over abortion recently, and Obama found himself in the middle of that debate recently when he accepted an invitation to speak at the commencement at the University of Notre Dame.

Conservative Catholics were angry with the Catholic school, and more than 60 bishops condemned the university for welcoming the president.

In the White House interview , Obama said he has not written off working with the American bishops because of the controversy, as some influential bishops have feared. He said he has accepted that there are areas in which he and the bishops would not agree.

"That's healthy," he said.

Staff writer Rob Stein contributed to this report.

For background, see
http://iowasecularists.org/forum/index.php?topic=1042.0

[Sfedler]

...a new policy would "certainly not be weaker" than what existed before Bush expanded it late in his administration.

Basically he's just turning back Bush's midnight clause he pushed through right before he left office, which I consider to be a good move.  And it will be a long process to reverse it.  The Bush conscience clause was unnecessary as there are already mechanisms in place for physicians to legally follow their consciences.  Obama did something similar in Illinois with a gun law, and got flak for it then, too, but really all he was saying then (and now) is that the additional law and/or regulations just reiterate what's already on the books.  I don't think Obama is really saying anything new in this article that he hasn't said before.

It seems where Bush's clause ran into opposition is where the physician could refuse to fill a prescription, for example (just like now), but could then refuse to give the prescription to someone who would fill it.  I think that's the part that was so objectionable.

[Niles]

Scot,

I think you mean pharmacist, not physician,

However, the issue you site - refusing to refer to another pharmacist - is a matter of state licensing laws.  Obama could completely overturn the Federal directive, and a specific state licensing law would remain in effect.

What the Bush administration did, was add provisions to laws - that are usually left to the states - and incorporate Federal funding.  That is, health care providers that accept
Federal funding - which is pretty much everyone (Medicare, Medicaid, VA referrals, and so forth) - would be required to comply.  Even more so, and pharmacists were the smallest of the problems, the "chain of conscience" went to ANYONE in the health care chain, even if that means that a sterility technician could refuse to sterilize products used in procedures for which the technician found objectionable.  Such provisions do exist in some state laws, by the way.

See
http://iowasecularists.org/forum/index.php?topic=1042.0
specifically
"Much of the proposed regulation is directed at entities involved in reproductive choices.  However, we believe the language of this proposed regulation is so broad, it allows a right of refusal for health care employees doctors, nurses, supporting staff, janitors, etc. for any procedure an employee opposes."

We will see what Obama does, of course.  Unfortunately, it is about six months since the regulation was issued, and it is still being considered and thus is still in force.

Using your example, by the way, in some religious doctrine, cooperating with a sin is still a sin, and there are some doctors who will refuse to even provide information about emergency contraceptive prescriptions to rape victims.   That is, refusing to write a prescription is one thing, but not giving information - within the critical 48-hour period is yet another.  Thus, what the pharmacist would - or would not do - becomes irrelevant, if the prescription is not even written.  This would still exist - under the laws of various states - notwithstanding whatever Obama does, or does not, do.  Without going into specifics in a public forum, I had such a personal experience at U of Iowa, but had both the time and the knowledge to follow up with my internal medicine physician and get an adequate resolution.

From the above link, however, the U of Iowa situation relates to:
"This language raises particular concerns about honoring end-of-life decisions by patients and their surrogate decision-makers and raises questions about how this clause will be interpreted in relation to existing law in many states.  This is particularly worrisome for patients at the end of life who are often unaware of their options and hesitant to initiate conversations with their providers about certain of those options. Compassion & Choices has filed an official comment opposing this proposed regulation, and encourages members to do the same."

That would not change, in Iowa, if the Obama administration were to completely obliterate the regulation.