DHHS regulations: open-letter (sent around)

In the midst of the media’s obsession with Bristol Palin’s “out-of-wedlock” hump and her mother’s decision to carry her Down Syndrome child, this is an open-ended letter concerning the new proposed regulations issued by the Department of Health and Human Services last Thursday, August 21st 2008.

These regulations, if passed, will greatly reduce the COMPREHENSIVE quality of reproductive health care that patients receive.  Under the guise of protecting a physician’s right to refuse to perform certain tasks based on moral or religious views, the HHS regulations are nothing more than an attempt to further erode patients’ ability to access complete and medically accurate health care. Conscience clauses have been in existence for decades, but under the proposed HHS regulations, a physician can refuse to not only perform certain medical procedure, but refuse to counsel or refer the patient to another physician. The regulations completely ignore the role of the physician as public servant, or as a health care provider responsible to their patients: the people that trust them to provide accurate and complete medical aid.  With these regulations doctors will no longer be required to provide sound medical care.

Current regulations forbid any institution receiving federal funding from discriminating against an employee based on diverging moral or religious views. If a physician has a moral objection to performing an abortion, s/he would not have to perform it but was expected to refer the patient to a physician willing to perform the procedure. These new proposed regulations go further, allowing the physician to refuse to perform options counseling or offer a referral. With access to good health care already a crisis in the United States, the HHS’ proposition places more barriers between patients and the quality health care they deserve. With the institutionalizing of these regulations a doctor’s personal moral or religious bias is given more credence than a patient’s need for good health care.  HHS funding for public health centers is created by the public, through taxes, and should be put toward programs that help the public, rather than being spent on programs that set the United States further behind the industrial world in terms of health care.

These regulations will impact the education that medical students will receive.  Under these regulations any healthcare professional will be able to refuse to “deal with” subjects that offend their sensibilities.  This means that not only could a doctor refuse to refer a patient to another physician who would be willing to provide the necessary care, but professors at publically funded medical schools can refuse to teach how to provide that care.  If these institutions ask a doctor, hired for the teaching of this care, to cover the subject, they would be at risk of losing their federal funds.  The implications here are that even future doctors who wish to learn how to provide comprehensive reproductive healthcare, may find it impossible to do so.  The United States is already facing a shortage of abortion providers and the HHS regulations if accepted will speed up the extinction of this necessary medical specialist.

Politics have no room in the examination room! The doctor is a specialist meant to provide healthcare, not restrict it.  And, as issues surrounding contraception and healthcare are frequently framed as moral dilemmas, I feel the need to ask what is more moral; to provide good comprehensive medical care, or to refuse?

In Peace and Health,
Yalda Afshar
MD/PhD candidate, Medical Scientist Training Program
University of Illinois at Chicago

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