An Open Letter to the Department of Health and Human Services Regarding Proposed Rule "Provider Conscience Regulation"

I am writing in opposition to the Department of Health and Human Services’ proposed “Provider Conscience Regulation.” This rule represents nothing more than another dastardly attempt by the current administration to pander to its right-wing base under the disingenuous guise of ensuring a more diverse healthcare workforce. This rule, if enacted, will violate the public’s right to receive unbiased medical information, all to assuage the so-called consciences of ideological bigots.

First, the proposed rule indicates that there exists a pervasive attitude of discriminatory hostility toward healthcare workers who refuse to participate in procedures to which they are morally opposed. As a registered nurse with over twelve years of experience who has worked in various practice settings in multiple states, I have never witnessed such an attitude. Where is the widespread evidence that healthcare workers are being fired and/or barred from professional organizations because of their individual beliefs? The rule also implies that professional organizations are misguided in setting standards for their practitioners that trump individual conscience. Professional standards are designed to encompass the broadest scope of ethical practice that serves the greatest public good. If practitioners cannot adhere to these standards due to conscientious objection, they need not belong to them.

Second, the proposed rule purports to create a more diverse healthcare workforce by ensuring that workers’ individual consciences, however biased or medically inaccurate they may be, will not be an issue in their employment. This is the most disingenuous portion of the entire regulation. A genuine way to create and sustain a more diverse healthcare workforce would involve a federal and state commitment to funding educational and mentoring programs, namely within communities of color and lower-income regions. In its current form, the only diversity the proposed rule aims to ensure is the unfettered tolerance of workers who oppose abortion and certain forms of birth control, both of which are critical women’s health issues.

Indeed, since abortion and sterilization are the only specific procedures mentioned throughout the proposed rule, one can only assume that these services are the ones the rule was designed to address. In this case, the rule is needless since regulations already exist to protect morally-opposed practitioners from being required to participate in the aforementioned procedures. Nevertheless, since the proposed rule does refer to “other medical procedures” to which practitioners may be opposed, I proffer the following situations for consideration. Does this rule aim to protect healthcare workers who refuse to administer blood products, participate in organ procurement and donation, perform CPR on a terminally ill patient, or assist with the provision of life-preserving care to a brain-dead patient on the basis of individual conscience and/or religious conviction? Furthermore, does it aim to protect those individual workers who wish to provide information about birth control, abortion, and sterilization to patients on the basis of their individual consciences within an organization that is wholly opposed on religious grounds, such as the many religious-affiliated hospitals referred to in the proposed rule?

Third, the proposed rule erroneously states that it will not limit patient access to healthcare. In fact, it will further reduce access to care, particularly for women seeking family-planning services, in rural areas where practitioners are few and far between or where religious-affiliated healthcare organizations dominate. It will disproportionately impact poor women who lack transportation and resources to travel to receive unbiased healthcare they rightfully deserve within their own communities.

This rule is concerned about the violation of individual conscience; I am concerned about the violation of public trust in the healthcare profession. As a nurse who witnesses firsthand the disastrous effects of federally funded abstinence-only education programs and faith-based organizations (i.e., crisis pregnancy centers) committed to ideological extremism, I am appalled that this administration condones clinical misinformation and the omission of critical healthcare options to the public in the name of individual conscience. Since when in a civilized democracy do the ideological persuasions of a select few get to determine the dissemination of information that impacts public health on such a grand scale? I implore the Department of Health and Human Services to consider the dire ramifications of championing the ideological extremism of individual workers, as well as state-sponsored coercion of healthcare entities to comply with this extremism as a condition for receiving federal funds. If enacted, the “Provider Conscience Regulation” will deal a direct blow to the public’s right to receive medically accurate information and options. It will flout professional standards of ethical practice and particularly endanger the lives of women and girls who will be at the mercy of ideological extremists in the examination room when they are most vulnerable. I strongly urge the Department of Health and Human Services to retract this proposed regulation. To do otherwise would dishonor and violate the public trust in the healthcare professions, a truly unconscionable act.