Medical conscience for me, but not for thee

Promoting a one-way conscience right favouring the medical intelligentsia

National Review

Wesley J. Smith*

The New York Times has published an opinion column by cardiologist Sandeep Jauhar that decries the Trump administration’s increased enforcement of medical conscience. But he actually promotes a one-way conscience right that favors protecting the predominate ideological views of the medical intelligentsia, while forcing dissenters to sacrifice their own religious and moral beliefs. . . [Full text]

OCR Issues Notice of Violation to the University of Vermont Medical Center After It Unlawfully Forced a Nurse to Assist in Abortion

News Release
For immediate release

US Department of Health and Human Services

Contact: HHS Press Office
202-690-6343
media@hhs.gov

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) is announcing that, after a thorough investigation and prolonged attempts to resolve the matter, OCR has issued a Notice of Violation letter finding that the University of Vermont Medical Center (UVMMC) violated the Church Amendments (42 U.S.C. 300a-7) by forcing a nurse to assist in an elective abortion procedure over the nurse’s conscience-based objections. OCR also found that UVMMC has discriminatory policies that assign or require employees to assist abortion procedures even after they have recorded their religious or moral objections to assisting in the performance of such abortions. OCR’s Notice of Violation letter asks UVMMC to conform its policies to the Church Amendments and take other corrective action, or face potential action by the HHS component from which UVMMC has received federal funding.

On May 9, 2018, a nurse at UVMMC filed a conscience and religious discrimination complaint with OCR against UVMMC, a medical center in Burlington, Vermont that receives HHS funds, contending that the nurse was forced to assist an abortion in violation of the nurse’s conscience rights. As part of its investigation, OCR contacted UVMMC repeatedly in a good faith effort to seek cooperation from UVMMC, but the hospital refused to conform its policies to federal conscience laws, provide all the documents requested by OCR, or produce witnesses for OCR interviews. Nevertheless, OCR interviewed multiple witnesses and gathered evidence concerning the allegations.

As a result of its investigation, OCR has specifically determined that:

  • UVMMC forced the nurse complainant to assist in an abortion against the nurse’s religious or moral objection. The nurse had expressed an objection for many years and was included in a list of objectors, but UVMMC knowingly assigned the nurse to an abortion procedure. The nurse was not told the procedure was an abortion until the nurse walked into the room, when the doctor—knowing the nurse objected to assisting in abortions—told the nurse, “Don’t hate me.” The nurse again objected, and other staff were present who could have taken the nurse’s place, but the nurse was required to assist with the abortion anyway. If the nurse had not done so, the nurse reasonably feared UVMMC would fire or report the nurse to licensing authorities.
  • OCR spoke with several other UVMMC health care personnel who, since at least the spring of 2017, have been intentionally, unnecessarily, and knowingly scheduled by UVMMC to assist with elective abortions against their religious or moral objections. Such personnel were often not told in advance that the procedures they were being assigned to assist with were abortions. Health care personnel who are coerced in that way suffer moral injury, are subjected to a crisis of conscience, and frequently experience significant emotional distress, even if they succeed in declining to assist in the procedure after the assignment is made.
  • UVMMC maintains a staffing policy that facially violates the Church Amendments because the policy admits to circumstances where UVMMC can and will force staff—on pain of adverse action or discipline—to participate in abortions against their moral or religious objections. The policy also violates UVMMC’s agreement, as a condition of receiving HHS funds, to comply with federal law, including the Church Amendments and HHS’s grants regulations.
  • Consequently, UVMMC is violating 42 U.S.C. § 300a-7(c)(1) of the Church Amendments by discriminating against health-care personnel who have religious or moral objections to abortion, and subjecting them to different terms or conditions of employment than other health-care personnel.

In the Notice of Violation, OCR asks that UVMMC notify OCR within thirty days whether UVMMC intends to work collaboratively with OCR to change its policies so it no longer requires health care personnel to participate in abortion against their religious or moral objections, and to take immediate steps to remedy the effect of its past discriminatory conduct. Otherwise, OCR indicates that it will forward the Notice to the Health Resources and Services Administration (HRSA), a component of HHS that provides grant funds to UVMMC, for consideration and possible additional procedures concerning UVMMC’s receipt of federal funds.  Since October 1998, UVMMC has received—and continues to receive—grants from HRSA.  For the most recently completed three-year project period, which ended April 30, 2018, UVMMC reported that it cumulatively expended $1.6 million of federal financial assistance.

Roger Severino, Director of OCR said, “Forcing medical staff to assist in the taking of human life inflicts a moral injury on them that is not only unnecessary and wrong, it violates longstanding federal law. Our investigation has uncovered serious discrimination by UVMMC against nurses and staff who cannot, in good conscience, assist in elective abortions.”  Severino concluded, “We stand ready to assist UVMMC in changing its policies and procedures to respect conscience rights and remedy the effects of its discrimination.” 

OCR is charged with helping ensure entities come into compliance with federal laws protecting conscience and prohibiting coercion in health care, including the Church Amendments.

ACLJ Vindicates Rights of Vermont Nurse Who Was Unlawfully Forced to Participate in Abortion – HHS Threatens to Pull Medical Center Funding

American Center for Law and Justice

Reproduced with permission

Jay Sekulow*

The ACLJ applauds today’s announcement by the Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) regarding a Complaint we filed on behalf of a Vermont nurse who was forced into participating in an abortion procedure against her deeply held religious beliefs.

In our Complaint, we alleged that our client, an operating room nurse at the University of Vermont Medical Center (UVMMC) in Burlington, was coerced into assisting in an abortion in 2017 even though her name was on a list of nurses who, for religious or moral reasons, were conscientiously opposed to such participation and even though other non-objecting nurses were available who could easily have taken her place.

In the more than two decades of work that ACLJ has done to defend the rights of conscience of pro-life health care workers, this is by far the most outrageous case we’ve ever seen. Our client’s most fundamental beliefs about the sanctity of life were simply brushed aside.

Worse, her superiors deliberately misled her into thinking she was assisting in a procedure following a miscarriage. But once trapped inside the OR she discovered that it was, in fact, an elective abortion and that this had been known all along by her superiors who then callously refused to relieve her. To say that she was emotionally traumatized by this event is putting it mildly.

At least four other nurses at UVMMC have confirmed that they too have been subjected to similar violations of their conscience rights. We forwarded them to OCR as part of our Complaint. And after conducting its own thorough investigation of the matter, OCR has substantiated their allegations.

In its announcement, HHS finds that UVMMC has committed violations of the federal Church Amendment – the so-called “conscience clause” – named for the late liberal Idaho Democratic Senator Frank Church. The law was enacted in 1973 as a response to the Supreme Court’s legalization of abortion in Roe v. Wade. In general, it prohibits entities that receive federal funding from discriminating against employees who refuse to perform or assist in the performance of abortions because of their moral or religious beliefs.

But, because the Church Amendment has always lacked a mechanism for enforcement by private citizens, its enforcement has depended on action taken by HHS itself. In the decades since 1973, however, such enforcement has, for all intents and purposes, been nonexistent. With today’s announcement, HHS’s Office of Civil Rights has, at long last, put teeth in a law that has lain largely dormant since its enactment.

HHS has given UVMMC 30 days to come up with a policy that will ensure that the things that happened to our client, and others like her, will not happen again. If they fail to cooperate, they lose their federal funding.

This action by HHS is an enormous step forward toward the full protection of conscience rights of all those in the health care field who recognize the sanctity of all human life. The repercussions of today’s action will be felt in every hospital and health care system in the country.

No longer should pro-life health care professionals have to fear that their values – the values of protecting, not, destroying, life – make them somehow unfit or unsuitable for the healing profession. No nurses, doctors, or other health workers should ever be deliberately trapped in a room and forced to participate in something that their employer knows those workers consider abhorrent at the core of their being.

For over two decades the American Center for Law and Justice (ACLJ) has been at the forefront of advancing and defending the right of free speech and conscientious objection when it comes to the sanctity of human life. In addition to our work with legislators and public policy makers in Washington and around the country, we have also represented dozens of individuals – women and men on the front lines of the pro-life cause – who have found themselves discriminated against because of their pro-life stands. Doctors, nurses, pharmacists, and other health care workers – we’ve gone to court for them before judges and juries from Maine to Hawaii and most points in between.

The ACLJ very much welcomes HHS’s vigorous enforcement of federal conscience rights in this case. No health care worker should be forced to abandon their career because they refuse to abandon their pro-life convictions. If you are a healthcare worker and have experienced a similar situation, please contact us at ACLJ.org/HELP.

Coalition Offended and Displeased with Recent Comments Attacking Conscience Rights

News Release

Christian Medical Association

WASHINGTON, July 25, 2019 /Standard Newswire/ — Today, a coalition of medical organizations released a public statement condemning recent statements on abortion and conscience protections made by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, the American Psychiatric Association and the American Osteopathic Association. The letter calls on this “Group of Six” to respect their position and represent all physician members in their public statements.

The coalition asserts in their statement to not use the “sanctity of the patient-physician relationship” as an excuse to passively ignore or actively reject the sanctity of human life, from conception to natural death. Furthermore, they encouraged their primary care colleagues to recognize the inherent right to life of all human persons, regardless of age, stage of development, physical or mental ability, physical location, state of dependency or the subjective designation of “being desired.” The coalition is calling for better and more equitable healthcare for all vulnerable populations, including improved access to maternal and fetal healthcare, and improvement on social determinants of health.

The coalition is made up of the American Association of Pro-Life Obstetricians and Gynecologists, American College of Pediatricians, Catholic Medical Association, Christian Medical Association, Coptic Medical Association, National Association of Catholic Nurses and The National Catholic Bioethics Center.

Executive Director of American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) Donna Harrison, MD, said, “The Hippocratic Oath forbids both abortion and euthanasia. Neither the Group of Six nor any other group can force a physician to violate the Hippocratic Oath on which the doctor patient covenant is founded.”

Executive Director of American College of Pediatricians (ACPeds) Michelle Cretella, MD, said “Americans need to realize that the Group of Six do not represent physicians who take an oath to first do no harm in the tradition of Hippocrates. The Hippocratic Oath logically forbids the intentional killing of human life from conception to natural death. Death is not a state of health; killing is not caring. Abortion, assisted suicide and euthanasia are not health care.”

Chief Executive Officer of Christian Medical Association (CMA) David Stevens, MD, MA (Ethics), said, “Physicians are leaving these medical professional organizations because they no longer represent their worldview. The coalition’s letter will only encourage efforts to force life-honoring professionals out of healthcare to the detriment of our healthcare system and, more importantly, our patients. Pro-life patients want a pro-life physician.”

Senior Fellow of The National Catholic Bioethics Center Marie Hilliard said, “It is important to always recognize when considering the perinatal provider-patient relationship that there are two patients whose best interest we are charged in enhancing. Abortion violates that obligation.”

President of National Association of Catholic Nurses, U.S.A. Diane Ruzicka, RN, MSN, said, “Physicians and nurses have a sacred responsibility to preserve and protect life. This was well known by the pagan Greek physician Hippocrates (430-370BC) credited with composing the Hippocratic Oath in which he stated, ‘I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.’ Translated by Michael North, National Library of Medicine, 2002.

“The natural moral law informs us that civilized societies do not kill their young.

“As a society founded on the natural moral law and Christian principles, the Bible which is the Word of God consigned to writing, reveals how precious is man:

  1. ‘Before I formed you in the womb I knew you….’ — God to Jeremiah in Jeremiah 1:5
     
  2. ‘Does a woman forget her baby at the breast, or fail to cherish the son of her womb? Yet even if these forget, I will never forget you.’ — God to Isaiah in Isaiah 49:15  
  3. Lastly, it was the unborn baby in the womb of Elizabeth who first recognized Jesus, the Savior of the world, in the womb of Mary. At six months gestation John the Baptist recognizes the newly conceived Jesus, God incarnate, the Word of God made flesh, in His mother’s womb. — Luke 1:41

“Human life is precious and of immense dignity. Physicians and nurses have a sacred duty to protect life from conception to the time of death ordained by God,” Ruzicka said.

The coalition’s full statement can be viewed here.

SOURCE Christian Medical Association

CONTACT: Margie Shealy, Margie.shealy@cmda.org, 423-844-1047

Hospitals and Health Industry in Limbo After Court Delays Implementation of “Conscience Rule”

Lexology

Duane Morris LLP

Regardless of whether organizations support or oppose the Conscience Rule, it is possible that it will become law on November 22 unless the courts and HHS move with uncharacteristic speed in a highly charged political arena.

Hospitals, health insurers and a variety of other healthcare entities do not have to be ready for a July 22 go-live date for the Trump administration’s “Conscience Rule.” Instead, the federal rule―designed to support health workers who opt out of providing patient care that violates their conscience, moral or religious beliefs―is facing such intense challenge in federal courts that the U.S. Department of Health and Human Services (HHS) agreed to a stipulated request to delay the effective date until November 22, 2019. . . [Full text]

23 States Sue Feds to Block HHS “Conscience” Rule Permitting Refusal of Care

Non Profit Quarterly

Ruth McCambridge

Twenty-three states joined in a suit filed on May 21st to block a new federal regulation known as the Protecting Statutory Conscience Rights in Health Care rule. Published yesterday in the Federal Register, it would give health care providers, insurers, and employers—as well as a wide range of others, such as ambulance drivers, receptionists, and customer service representatives at insurance companies—the right to refuse to provide or pay for medical services that violate their religious or moral beliefs. These services would include abortion and other reproductive services, as well as assisted suicide. Additionally, any health care provider would risk federal funding if they do not respect the right of these workers to deny service. . . [Full text]

HHS Final Conscience Rule and Protected Employees

Hall Render Killian Heath & Lyman PC

Robin M. Sheridan and Lindsey Croasdale

On May 2, 2019, the U.S. Department of Health and Human Services (“HHS”) Office of Civil Rights (“OCR”) announced the issuance of the final conscience rule, which prohibits discrimination of individuals on the basis of their exercise of conscience in HHS-funded programs. The rule has not yet been published in the Federal Register, but HHS has released an unofficial version of the document. This rule will be effective 60 days after is it published in the Federal Register. . . [Full text]

Christian Medical Association Doctors Laud HHS Conscience Rule as Protecting Patients and Doctors

News Release

Christian Medical Association

WASHINGTON, May 2, 2019 /Standard Newswire/ — The 19,000-member Christian Medical Association, the largest national association of faith-based doctors, lauded a conscience law-enforcing rule finalized today by the U.S. Department of Health and Human Services (HHS) as a protection for both patients and doctors.

CMA CEO Dr. David Stevens said, “Our patients need to know that we as doctors can be trusted to conscientiously adhere to objective ethical standards and moral commitments that serve to protect them. They need to know we are not going to lay aside longstanding ethical norms and medical concerns just because ideologically-driven politicians or bureaucrats or hospital administrators might pressure us to do so by threatening our ability to practice medicine.”

CMA Senior Vice President Dr. Gene Rudd, an OB/Gyn physician, said, “In recent years, some abortion advocates have proposed effectively banning pro-life physicians from medicine, essentially because we adhere to the Hippocratic Oath. That long-standing objective standard protects our unborn patients while also protecting our born patients from other abuses of medical power such as involuntary euthanasia and sexual abuse. Without pro-life OB/Gyn physicians, who will serve the millions of women and men who also hold to pro-life commitments?

“Conscience protection is one of the treasures of our society. It is enshrined in the First Amendment of the Constitution, reflecting its importance. Some would want to take this right away from others when they disagree on certain issues. But protection for each person is critical to protection for all. The HHS conscience rules are critical to preserving this freedom.”

CMA Executive Vice President Dr. Mike Chupp observed, “We are committed to serving every kind of patient with compassion and competence, but that’s very different from saying we will do any procedure or fill any prescription regardless of ethical or medical concerns. Healthcare professionals of faith and conscience are committed to the mantra ‘Anyone, Anytime, Anywhere but NOT Anything!’ Without conscience freedom in healthcare, whatever ideology the government chooses will be the grounds used to exclude all objectors. The result would be a loss of healthcare access for patients, and especially the patients of faith-based health professionals who often minister to the underserved and marginalized.”

CMA Vice President for Government Relations Jonathan Imbody noted, “This HHS rule enforces and educates regarding existing conscience laws passed by Congress on a bipartisan basis, back when Congress was more bipartisan. The rule reminds the government and the health community that we all live in a country that values freedom of conscience and tolerance of diverse views. Conscience freedoms protect liberals, conservatives and everyone in between, on issues ranging from capital punishment to abortion to research ethics. Without tolerance for diversity and conscience convictions in healthcare, patients lose access to doctors, and health professionals lose their careers.”

More information available at www.Freedom2Care.org:

  • Stories of conscience violations
  • Previous polling by Kellyanne Conway on conscience (e.g, 92 percent of faith-based physicians said they would leave medicine rather than compromise conscience)
  • CMA comments submitted to HHS on conscience rule

SOURCE Christian Medical Association

CONTACT: Margie Shealy, 423-341-4254

Related Links  www.Freedom2Care.org

HHS Announces Final Conscience Rule Protecting Health Care Entities and Individuals

News Release
For immediate release

US Department of Health and Human Services

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced today the issuance of the final conscience rule that protects individuals and health care entities from discrimination on the basis of their exercise of conscience in HHS-funded programs. Just as OCR enforces other civil rights, the rule implements full and robust enforcement of approximately 25 provisions passed by Congress protecting longstanding conscience rights in healthcare.  

The final rule fulfills President Trump’s promise to promote and protect the fundamental and unalienable rights of conscience and religious liberty, a promise he made when he signed an executive order in May 2017 protecting religious liberty.  In October 2017, the Department of Justice issued guidance encouraging other Departments, including HHS, to implement and enforce all relevant religious freedom laws.  

As a result, in January 2018, following the launch of its new Conscience and Religious Freedom Division, HHS announced the proposed conscience rule.  OCR received over 242,000 public comments, and analyzed and carefully considered all comments submitted from the public on the proposed conscience regulation before finalizing it.

This final rule replaces a 2011 rule that has proven inadequate, and ensures that HHS implements the full set of tools appropriate for enforcing the conscience protections passed by Congress.  These federal laws protect providers, individuals, and other health care entities from having to provide, participate in, pay for, provide coverage of, or refer for, services such as abortion, sterilization, or assisted suicide.  It also includes conscience protections with respect to advance directives.

The final rule clarifies what covered entities need to do to comply with applicable conscience provisions and requires applicants for HHS federal financial assistance to provide assurances and certifications of compliance. The rule also specifies compliance obligations for covered entities, including cooperation with OCR, maintenance of records, reporting, and non-retaliation requirements.

“Finally, laws prohibiting government funded discrimination against conscience and religious freedom will be enforced like every other civil rights law.” said OCR Director Roger Severino. “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. Protecting conscience and religious freedom not only fosters greater diversity in healthcare, it’s the law,” Severino concluded.

Click here to read the Final Conscience Rule.

Click here – PDF to read the Final Conscience Rule Factsheet.

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*This HHS-approved document is being submitted to the Office of the Federal Register (OFR) for publication and has not yet been placed on public display or published in the Federal Register.  This document may vary slightly from the published document if minor editorial changes are made during the OFR review process.  The document published in the Federal Register is the official HHS-approved document. 

*People using assistive technology may not be able to fully access information in these files.  For assistance, please email OCR at OCRMail@hhs.gov or contact the OCR Call Center at (800) 368-1019.

Contact: HHS Press Office 202-690-6343 media@hhs.gov

HHS rules prevent providers from being forced to do things that violate moral convictions

The Hill

Reproduced with permission

Diana Ruzicka*

In the April 4, 2018 article, HHS rule lowers the bar for care and discriminates against certain people, nursing leaders, Pamela F. Cipriano and Karen Cox, wrote that the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Proposed Rule: Protecting Statutory Conscience Rights in Health Care; Delegations of Authority expands the ability to discriminate, denies patients health care and should be rescinded. These accusations are unfounded and the rule should be supported.

What the rule does is “more effectively and comprehensively enforce Federal health care conscience and associated anti-discrimination laws.” It is not an effort to allow discrimination but an effort to prevent it by enforcing laws already on the books and gives the OCR the authority to oversee such efforts. This is something that nursing should encourage because it supports the Code of Ethics for Nurses (code).

The code reminds us that, “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence and continue personal and professional growth.”

It is precisely because nurses are professionals who hold themselves to these standards that patients have come to see nurses as persons worthy of their trust, persons in whose hands they are willing to place their lives. Being granted by the public this weighty and solemn responsibility is humbling and must never be taken lightly. Thus the nurse’s duty to practice in accord with one’s conscience, to be a person of wholeness of character and integrity, is recognized by the.

It is odd that, despite supporting a nurse’s duty to conscience and the right to refuse to participate in an action to which the nurse objects on the grounds of conscience, Cipriano and Cox insist that the nurse, must assure that others make the care available to the patient. This suggests a failure to recognize that referring the patient to someone who will do the objectionable act in place of the nurse can make the nurse complicit.

The culpability of complicity is well recognized in law and ethics, as an accomplice is liable to the same extent as the person who does the deed. Thus, to make a referral and be complicit in an act to which the nurse conscientiously objects, also violates conscience. We doubt nursing leaders actually support this, as the consequences would be chilling.

When persons are made to violate their conscience, to set it aside, to silence it, moral integrity is eroded and moral disengagement progressively sets in. To move from caring for our fellow human beings to acting on them in ways that our conscience tells us we should not, requires powerful cognitive manipulation and restructuring to free ourselves of the guilt associated with this violation of our deeply held moral or religious beliefs.

Moral disengagement has frightening negative consequences, namely a pernicious dehumanization of persons, including oneself and of society as a whole. Rather than a nurse being someone of moral courage, ethical competence and human rights sensitivity, as our code directs, a nurse would have to be someone who is willing to surrender their conscience to expediency, powerful others, or whatever happens to be permitted by law at the time and place.

No longer would patients find that nurses are persons they can trust. It is precisely because nurses practice in accordance with their conscience that the public continues to grant them high scores on honesty and ethics.

None of this is to say that nurses may abandon patients. By promptly seeking a transfer of assignment that does not involve the objectionable act or by transferring the patient elsewhere without making a referral, the nurse continues to uphold the code by “promoting, advocating for and protecting the rights, health and safety of the patient [and, at the same time,] preserving wholeness of character and integrity.”

Clearly, refusal to care for a patient based on an individual attribute is unjust discrimination and has no place in nursing or health care. But that is not what the rule does. It protects the right to object to being forced to participate in an act that violates a person’s deeply held moral convictions or religious beliefs and from discrimination as a result of one’s refusal to participate in such an act.

To call for rescinding the rule, whose purpose is to protect this fundamental human right, would be short-sighted and could make unjust discrimination more likely and harm not only nursing but also the patients we serve.