‘Conscience’ Shield Vital, Many Caregivers Say
Kim McAllister, a Bay Area nurse for 31 years, knows she can recuse herself from a medical procedure with which she has a moral conflict.
If a patient wants an abortion or if McAllister sees an end-of-life decision she might question, she can discreetly find another nurse who would help the patient in the way the patient seeks.
But, like many Catholics, evangelicals and others, McAllister now worries that an Obama administration proposal to repeal “conscience” protections for health care workers will imperil her rights.
“I took it for granted that my beliefs were protected,” said McAllister, 51, of Hayward. “I’m concerned.”
The right of health care workers to recuse themselves from medical procedures, particularly abortion, has been around at least since the U.S. Supreme Court’s ruling in Roe vs. Wade in 1973. But it has come to the forefront in recent months with a recent move by the Obama White House to revoke a rule set in the last month of the Bush administration.
In December, the Bush regulation established a system for cutting off federal funding for local and state governments, hospitals, health plans, clinics and other medical care entities if they did not accommodate doctors, nurses, pharmacists and others who decline to do medical procedures that they feel violate their moral or religious beliefs. In February, the Obama administration moved to rescind it.
The U.S. Department of Health and Human Services is reviewing comments from the public and advocacy groups about the Obama proposal.
The fallout has provoked uproar among religious conservatives, some of whom believe that Obama’s proposal threatens their very right to be medical providers. It is provoking anxious discussions among many Catholic doctors and nurses, said the Rev. Gerald Coleman, vice president of corporate ethics at the Daughters of Charity Health System, which runs Seton Medical Center in Daly City, O’Connor Hospital in San Jose and St. Louise Hospital in Gilroy.
Coleman sits on the ethics committees of all of his system’s hospitals, and he believes some of the concern is overblown.
“What I think is far-fetched is if people say Obama is simply going to erase conscience clauses,” Coleman said. “That’s simply not true.”
Advocates of the Bush regulation say it created clearer systems to report moral discrimination. William Cox, president of the Alliance of Catholic Health Care, said the regulation also offered stiff penalties – billions of dollars in the case of California, for example, if the state were found to discriminate against moral objectors to medical procedures.
“The regulation was a response to intensified attacks on conscience rights,” said Cox, whose association represents all 54 Catholic hospitals in the state. Those account for 16 percent of the state’s hospitals.
Without the streamlined Bush process of redress, workers would have to sue if they believe they have been discriminated against by their employer, said Cox, adding that Health and Human Services has not done enough to remedy the issue.
But opponents of the Bush regulation say it might have threatened the rights of those who have different views on medical issues than religious conservatives. They say the Bush regulation potentially infringed on their right to provide abortions, vasectomies and contraceptives – as well as information about them.
It is unclear, for example, whether abortion services providers would be viewed as discriminatory if they refused to hire people who didn’t believe in abortion, said Lilly Spitz, chief legal counsel for Planned Parenthood Affiliates of California. She said the regulation also potentially threatened the organization’s ability to vet volunteers.
“If we didn’t have the opportunity to find out if our volunteers were in support of our mission, that would totally undermine our ability to provide the services, advocacy and education we provide to the community,” Spitz said.
She said she believes the Bush regulation is unnecessary because a litany of laws protects employees’ rights to not participate in medical procedures. They include the Fair Employment and Housing Act and the Unruh Act on the state level, and, on the federal level, the Civil Rights Act, which prohibits discrimination based on religion.
Jon O’Brien, president of Catholics for Choice, said his organization wholeheartedly supports long-held protections for individual health care providers to recuse themselves based on conscience.
But, he said, giving entire hospitals or health care systems the blanket protection called for under the Bush plan threatens the freedom of nurses or doctors to give services they believe patients need.
Principles of individual
O’Brien said that if a doctor believed a patient had the right to have an abortion or be referred to one, such as in the instance of a raped child, a hospital should not stand in the way. Catholic tradition, he said, values individual conscience above that of an institution.
“They’re trying to say the institution has a conscience,” O’Brien said. “But by saying that, they’re denying the conscience of doctors, nurses and patients.”
McAllister, the Hayward nurse, said these issues play out much more subtly in a hospital.
Nurses often step in for each other if another nurse might be better suited, both in terms of skills or moral decisions. And, in her experience, hospitals do not override what doctors or nurses believe is appropriate.
At a Catholic hospital McAllister worked at, a patient asked a doctor for a “morning-after pill,” which can prevent conception within 72 hours of unprotected sex. Many Catholics view it as a form of abortion. The doctor wrote the prescription.
If a patient asks for a phone number for Planned Parenthood, McAllister will give it.
“My unwillingness to participate in certain procedures should have no bearing on whether that patient has access to other facilities for that help,” she said. At the same time, she said, she shouldn’t be forced to compromise her beliefs either. “I have to live with me.”
The article originally appeared in the San Francisco Chronicle.