WASHINGTON -- Healthcare workers who object to participating in certain services or procedures "on account of religious beliefs or moral convictions" will have an easier time asserting their rights under a by the Department of Health and Human Services.
The rule makes plain that workers cannot be compelled to participate in abortion, sterilization, or assisted suicide procedures, but is vague about other services -- such as hormonal and surgical treatments for transgender individuals -- that some health professionals may also find objectionable on moral grounds.
"Finally, laws prohibiting government funded discrimination against conscience and religious freedom will be enforced like every other civil rights law," Roger Severino, director of the HHS Office for Civil Rights, which issued the rule, said in a statement. "This rule ensures that healthcare entities and professionals won't be bullied out of the health care field because they decline to participate in actions that violate their conscience, including the taking of human life."
The 440-page final rule, which applies to healthcare workers in certain government-funded programs, outlined the reasons why such as rule was necessary. "In a 2009 survey of 2,865 members of faith‐based medical associations, 39% reported having faced pressure or discrimination from administrators or faculty based on their moral, ethical, or religious beliefs," the rule said. "Additionally, 32% of the survey respondents reported having been pressured to refer a patient for a procedure to which they had moral, ethical, or religious objections."
The authors noted that the HHS had issued a rule in 2008 that "sought to address an environment of discrimination toward, and attempted coercion of, those who object to certain health care procedures based on religious beliefs or moral convictions. Yet in February 2009, the department announced its intent to rescind the 2008 rule just one month after its effective date. It completed that rescission in 2011 ... since 2011, conscience and coercion in health care have been the subjects of significant litigation at the state and local level."
The rule does not add any new laws; it merely strengthens enforcement of rules already on the books to protect providers' religious beliefs, Severino said in a conference call with reporters. Those rules include:
- The , which bars federal agencies from making grants to entities that discriminate against healthcare providers who don't provide abortions
- The , which prohibits the federal government from discriminating in grants or loans on the basis of whether the entity is willing to perform sterilizations or abortions
- The , which says the federal government and state governments can't discriminate against entities that refuse to undergo training in how to perform abortions, or to provide such training
HHS dismissed the idea that the new rule, which also will apply to those objecting to contraception and assisted suicide, will decrease access to care in already underserved communities, noting that it doesn't expand current anti-discrimination or conscience laws already on the books.
"To the extent commenters believe the rule would reduce services in underserved communities, that would seem to be based on an assumption that there are health care providers in underserved communities who are protected by these laws but are offering services to which they object anyway (for example, abortions or abortion referrals) because the laws are inadequately enforced," the authors of the rule wrote.
"That is not necessarily a correct assumption. Such health care providers might be responding to a threat to their conscientious practice, not by offering the services despite their objections, but by leaving the health care field or a particular practice area involving that service."
Instead, the authors argued, "the rule might result in an increase in the number of providers overall, or in certain specialties within the healthcare field. Individuals and entities may have chosen not to enter the health care field because they anticipated they would be pressured to violate their consciences."
One of the rule's provisions also addresses vaccination laws, which have come under controversy recently in the wake of the measles epidemic. "The rule itself has a vaccination provision related to state religious exemptions," Severino said on the call. "In certain pediatric vaccine programs, the entities covered should be following religious exemptions provided for under state law. The rule does nothing to preempt any state laws."
Healthcare and legal groups were quick to respond to the new rule.
"This rule is a serious threat to health care access and the health and well-being of people across the country," Meera Shah, MD, a fellow with Physicians for Reproductive Health, a pro-reproductive rights organization, . "The impact will be felt most by women, people of color, and LGBTQIA patients, who are more likely to face discrimination and be refused health care like abortion and contraception. All people are deserving of comprehensive, compassionate health care. It's time for the Trump-Pence administration to stop trying to dismantle the policies that help keep people healthy and safe."
"The health care refusal rule threatens the integrity of key HHS programs, including the Title X family planning program," said Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, . "Title X cannot achieve its mission if HHS is allowed to circumvent federal law requiring grantees, providers, and contractors to provide treatment, counseling, or other medical information. This final rule ignores the needs of the patients and individuals served by HHS' programs and will create significant confusion about the rights and responsibilities of health care providers and entities."
Others disagreed. "Unfortunately, ADF clients and other nurses, doctors, and health care providers have faced discrimination and even have lost their jobs because of their commitment to saving life," Kellie Fiedorek, legal counsel at the Alliance Defending Freedom (ADF), a pro-religious rights organization, . "We commend the Trump administration and HHS for this commonsense rule that simply ensures longstanding federal conscience laws are enforced so that no American is forced to choose between violating their beliefs and serving those most in need."
The rule will become effective 60 days after it is published in the Federal Register, which is expected "very soon," Severino said.
Washington Correspondent Shannon Firth contributed to this story.