"Conscience Rule" for Health Care Workers Revised

The Obama administration has rescinded sections of a federal regulation designed to protect health care workers who refuse to provide health care treatments or procedures because of their moral and religious beliefs. The controversial "conscience rule" was proposed in August 2008 and took effect on Jan. 20, 2009, the final day of the administration of President George W. Bush.

Critics of the regulation, as promulgated by the Bush administration, claim that the rule is overly broad and has limited patient access to health care treatments, which are permitted under federal and state laws. According to sources familiar with the issue, courts and enforcement agencies have interpreted that the regulation offers protections to health care workers who refuse to participate in or offer health care services such as filling prescriptions for birth control pills, caring for homosexuals with AIDS and performing in-vitro fertilization for single women. Since the rule took effect, several high-profile cases, such as a pharmacist in California refusing to fill prescriptions for an emergency contraceptive and an ambulance driver in Chicago refusing to transport a woman who needed an abortion, have made headlines.

The new rule revisions developed by the Obama administration do not rescind the existing regulation and leave intact "conscience" protections for doctors and nurses who choose not to perform abortions or sterilizations. The new regulation keeps in place a process that allows health care workers who believe that their rights have been violated to file complaints.

In a written statement released on Feb. 18, 2011, officials with the Department of Health and Human Services (HHS) said the final rule "reaffirms the department's commitment to longstanding federal conscience statutes by maintaining and building upon provisions of the Bush administration rule that established an enforcement process for federal conscience laws, while rescinding the definitions and terms of the previous rule that caused confusion and could be taken as overly broad."

White House officials announced plans to rescind the Bush rule entirely, when Obama took office in January 2009, but the process proved to be highly controversial and complex. The Obama administration decided on a compromise approach after reviewing nearly 300,000 comments when a proposal to rescind the rules appeared in The Federal Register in March 2009.

Supporters of the Bush rule claim that it is needed to help enforce and strengthen a variety of federal laws that provide protections to health care workers for their rights of conscience. Many of the laws have been on the books for dozens of years but were enforced loosely. The 2008 regulation helped strengthen the protections and enforcement of the laws, supporters argue.

Opponents of the regulation, as enacted by the Bush administration, claim that it created overly broad protections that essentially allowed any health care worker to refuse providing certain services, such as allowing receptionists in doctors' offices to refuse making appointments for abortions or AIDS patients.

The HHS announcement that portions of the regulation will be revised and rescinded drew praise from several health care advocacy groups that claim that the rule has endangered lives by limiting access to adequate medical care.
The rule revision could intensify the debate in Congress over controversial health issues. Republican lawmakers in the House of Representatives have introduced several pieces of legislation that would turn some provisions of the Bush rule into federal law.

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