The new “conscience rule”

    A hotly debated Bush Administration rule for health workers goes into effect January 19th.

    When President-elect Barack Obama takes office he’ll inherit a new regulation from the Bush Administration that could pit the beliefs of health care workers against the needs of patients.

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    The so-called “conscience rule” provides legal backing for health care workers who don’t want to give information or care that’s at odds with their convictions.

    Caplan: The law is coming down on the side of the individual trying to carve out more room for conscientious objection for personal moral beliefs.

    Arthur Caplan leads the Department of Medical Ethics at the University of Pennsylvania. He says under the regulation, society’s push to make certain medical options available is trumped by the rights of individual workers.

    Caplan: The pharmacist who says: I don’t want to write that prescription for contraceptive pills. The nurse who says: I’m not sure I’m comfortable removing a feeding tube because it violates my moral conviction.

    Under the rule, these health workers could refuse to treat patients without telling their employer, even if that action sidesteps the mission of the place where they work. Some are calling the regulation an 11th-hour attempt by the Bush Administration to appease anti-abortion groups. But John Haas — the president of the National Catholic Bioethics Center — says the rule is an effort to protect workers.

    Haas: There have been incursions on health care professionals being able to use their best medical judgement and act in accord with their conscience.

    Haas gives the example of a California doctor who was sued when she cited religious reasons in refusing to provide fertility treatment to a lesbian woman.

    Dayle Steinberg is president of Planned Parenthood Southeastern Pennsylvania. Her group opposes the rule. She says the regulation allows individual medical professionals to block access to abortion and contraception options.

    Steinberg: There’s nothing in the regulation that requires health care workers to tell the patients that they’re withholding information.

    Anti-abortion and abortion-rights groups are clashing over the rule, but obstetrician Anita Nelson says the debate goes beyond the realm of reproductive health. She uses the example of a doctor who opposes blood transfusions.

    Nelson: Not only does he not have to offer transfusion to his patient, but he doesn’t even have to refer the patient to a place where the patient can get blood. This is so very vague.

    Drug stores and hospitals may struggle as they try to carry out the rule. Ethics expert Arthur Caplan says he expects push back from employers who are forced to keep workers who don’t follow company policies.

    Caplan: I do think people do have the right to say there are things they can’t bring themselves to do individually but at the same time employers they can’t make carve outs and get their job done efficiently and economically if they’ve got to make provision for every single person’s personal value list if you will.

    The rule goes into effect the day before Barack Obama takes office, and Caplan predicts it may linger on the books without any meaningful enforcement from the Department of Justice. Supporter John Haas expects the new administration to challenge the rule immediately.

    Haas: I think that it will at least buy us some time in terms of other initiatives that we might look to to protect consciences of health care professionals.

    Both advocates and opponents say the conscience rule will likely end up in the courts.

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