Tuesday, December 2, 2008

Bush's Proposed Rule Change in re Abortion

Okay, I've found a copy of the actual proposal (H/T to Pam's House Blend) After slogging through the legalese, I've come to the following the conclusions:
1) The proposed rule isn't a rule change as much as it is a way to enforce those rules already in place.
2) The proposed rules and new definitions are contradictory
3) Bush is still an ass.
4) There is much room for abuse.

Point one: This rule mentions three "amendments" already in place. One, known collectively as the Church Amendments, was written in the 1970s and was created to specifically address conscientious objectors to abortion. Another, known as the Weldon Amendment, already defines "health care entity" in almost the same language as the proposed rule. The third, The Public Health Services Act from 1996, addresses funding and non-discriminatory practices. The gist of the proposed rule is to require that health care providers certify that they will comply with these rules in much the same way that they already certify that they will abide by federal nondiscrimination laws regarding race, color, national origin, religion, sex, handicap, age, drug abuse, and alcohol abuse or alcoholism.

Point Two: Here's where things get dicey. The rule attempts to define certain terms that the Department of Health and Human Services feels are unclear. Most importantly, they define "the term “assist in the performance” to members of an entity’s workforce, the Department proposes to include participation in any activity with a reasonable connection to the objectionable procedure, including referrals, training, and other arrangements for offending procedures." This means that anyone even peripherally involved in the "procedure" can refuse to participate if the "procedure" violates their conscience. They also define "health service program" to include Medicare and Medicaid but later say that three exceptions to the written certification are : "(1) physicians, physician offices, and other health care practitioners participating in Part B of the Medicare program; (2) physicians, physician office, or other health care practitioners which participates in Part B of the Medicare program, when such individuals or organizations are sub-recpients of Department funds through a Medicare Advantage plan; and (3) sub-recipients of state Medicaid programs (i.e., any entity that is paid for services by the state Medicaid program)." Their rationale: there's too many of them. This part is so confusing I'm going to quote it in its entirety:

"While other providers participating in the Medicare program as well as state Medicaid programs would be required to submit written certification of compliance to the Department, the large number of entities included in these three categories poses significant implementation hurdles for Departmental components and programs. Furthermore, the Department believes that, due primarily to their generally smaller size, the excepted categories of recipients and sub-recipients of Department funds are less likely to encounter the types of issues sought to be addressed in this regulation."

Doesn't this look like to you that in one part of that sentence they say there's too many of them and they would overwhlem the department and then they say in the next sentence that these categories will be smaller and less likely to encounter abortions? Is anyone else confused by this?

So they try to broaden the definitions in the current regulations while at the same time they contradict themselves in who is supposed to provide this all important written certification.

Point 3: Self-explanatory.

Point 4: Though they do say several times that this proposed rule is in regards to abortion and sterilization, by addressing these points in broad and general language, they open them to broad and general interpretation. For example, the proposed rule states: "The statutory provisions discussed above require that the Department and recipients of Department funds (including State and local governments) refrain from discriminating against institutional and individual health care entities for their participation or refusal to participate in certain medical procedures or services, including certain health services, or research activities funded in whole or in part by the federal government." (my emphasis) To me, this looks like a way for "health care entities" to opt out of a whole plethora of services up to and including stem cell research, abortions, birth control and even the refusal of care for transgendered or homosexual persons.

This is the slippery slope that I've referenced before. We already have ample protections in place for those who have a conscientious objection to abortion. Expanding that to include "participation in any activity with a reasonable connection to the objectionable procedure" could be interpreted to mean that not only could a doctor or hospital or anyone working or volunteering for them could refuse to perform an abortion or provide materials, training or assistance for abortions but they could refuse to perform or to provide assistance to any procedure they found objectionable. The concern is that this "rule" could be used to permit the refusal of hormone treatments for transgendered individuals, artificial insemination for lesbians and more.

I am at once torn and angered. Torn because I believe that individuals have the right of refusal and the right to follow their conscience, religious and cultural beliefs. And angered because I see this as one more way to control women by limiting their options and to start the slide towards prejudicial treatment of an entire subset of our nation. It is an old quandary for any democratic society: can the rights of one group supersede the rights of another?

I have a friend who is a devout Catholic and a nurse. Where do her rights to follow her religion and her personal ethics end and the rights of her patients to receive treatment and information begin? There is no easy answer. For in granting one, we deny the other. There must be a balance in our society between the rights of opposing groups. My friend has the right to refuse to perform abortions, but does that right extend to refusing to give information because it might result in an outcome she finds personally abhorrent? This rule would say that the answer is yes.

Yet how can we as a society condone the potential of refusal of care for LGBT persons because their EMT or doctor or the janitor might find their "lifestyle" objectionable? Are we really ready to deny the inherent humanity of these individuals? How can we as a society tell the rape victim that she has to interrogate her ER doctor or nurse on their personal beliefs before she can expect to find treatment to prevent a potential pregnancy? How far will we go to accommodate the religious beliefs of one group at the expense of the basic human rights of another?

When you find the answer, please let me know.


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Chris said...

Wow, this is a hard one...but as a nurse, I can't imagine not putting a patient's basic need before my own personal opinion or belief. If you go into medicine or nursing, you should do your job first, and if you can't you're in the wrong profession, or maybe specialty area....when are we going to stop being so silly!!!?