The HHS's assault on patient health is unethical

The HHS's assault on patient health is unethical
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Throughout medical training, physicians are taught to provide quality care to all patients, no matter their personal beliefs, sexual orientation, or gender identity. However, the ability to discriminate along these dimensions has been protected for decades through a set of “conscience protection” laws.

Until now these laws have largely been unenforced in order to protect patients. But recently, under the guidance of the White House, the U.S. Department of Health and Human Services (HHS) has taken strides towards creating a medical system where discrimination against women, adolescents, and LGBT individuals is not only acceptable but applauded as a civil right victory for health-care workers.

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Last week the department announced the formation of the Conscience and Religious Freedom Division  within the Office for Civil Rights (OCR), led by Roger Severino, a lawyer known for his staunch support for anti-trans policies.

 

This division will possess unprecedented Orwellian authority to “initiate compliance reviews, conduct investigations, [and] supervise and coordinate compliance by the Department” and those who receive HHS funds. Furthermore, HHS proposed a rule that will enforce 25 existing “conscience protections” statutes within the U.S. code.  

Ostensibly, this proposed rule protects health-care providers who have religious or moral objections to abortion, sterilization, and assisted-suicide. But, if it were as simple as protecting individual health-care providers from performing interventions that are against their religious beliefs, most of us would support the effort; after all, creating a comfortable work environment where diversity is celebrated allows us to do our best best work and provide high quality care to our patients.  

But language matters. As currently written, these policies offer the ability to enforce decades-old laws like the Church amendment which include phrases such as: “no individual shall be required to perform or assist in the performance of any part of a health service program...if his performance...would be contrary to his religious beliefs or moral convictions.”

This language protects any health-care provider from providing any care to anyone with whom they disagree with on any religious or moral grounds. This language is broad sweeping, irresponsible, and dangerous.

There is no limit to the number of stories in recent years of young women denied access to emergency contraception, patients being denied care because they had an abortion, or individuals being turned away from clinics because of their gender/sex identity.

But here are the simple truths. One in four women will have an abortion in their lifetime. Over 99 percent of women have used some of contraception in their lifetime. More than 10 million women rely on female sterilization for birth control. And tragically, the rates of attempted suicide among transgender individuals are 22 times that of the general population.

Laws that perpetuate discriminatory behaviors should not be tolerated, and the medical community should make this louder and clearer than ever before. The codes of ethics for reputed medical organizations like the American Medical Association, American Nurses Association, and American College of Obstetrics and Gynecology all share common views: Health-care providers can conscientiously object to care that conflicts with their beliefs but only in very limited settings, precluding emergencies, and ensuring that the patient receives care from another qualified colleague.

The patient and the basic ethical principles of beneficence, non-maleficence, and patient autonomy are paramount. It is our collective duty to care for all patients — not just some.

These measures taken by this administration have the potential to further disenfranchise already marginalized individuals. Amongst our many inalienable rights, is the right for religious liberty. And, as Severino himself says, “fundamentally, protecting the rights of Americans of faith, [and] living up to our constitutional obligations, is about building a nation of tolerance.”

Clearly, his notion of tolerance is unidirectional. For the rest of us who chose to provide unbiased care and an environment of tolerance for our patients, we will have to keep fighting.

Dr. Namrata Mastey is an obstetrician-gynecologist in Boston, Mass. and affiliated with Massachusetts General Hospital and Brigham and Women’s Hospital. The opinions expressed in this article are solely her own and do not reflect the views and opinions of either institution.