As the Trump administration finalized a new 440-page rule Thursday strengthening protections for healthcare workers who refuse to provide care that violates their religious or moral beliefs, proponents and opponents quickly drew a line in the sand.
The reactions were as expected. Proponents, including pro-life groups, praised the final rule (PDF) for protecting the religious beliefs and moral convictions of medical professionals. Opponents said the rule will allow discrimination against patients, including women and LGBTQ people.
The new rule was announced Thursday by President Donald Trump during remarks at the White House Rose Garden on the National Day of Prayer.
The final rule does not create any new laws but provides enforcement tools for 25 laws passed by Congress that are already on the books, Roger Severino, director of the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR), which will enforce the rule, said in a press briefing Thursday.
"We are giving these laws life with this regulation," said Severino, adding that his agency wants to keep workers from being “bullied” out of healthcare because of their beliefs. The rule will protect providers, individuals and other healthcare 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, OCR said.
The rule will make it “so that people do not have to shed their religious beliefs to participate in healthcare,” said Severino. For instance, students cannot be excluded from medical training because they are unwilling to participate in abortions, he said, adding that the OB-GYN profession should not be a “pro-life free zone.”
Last year, HHS received more than 1,300 complaints alleging discrimination in a healthcare setting because of religious beliefs or conscience issues. “There is a problem out there … We’ve seen troubling actions across the country,” Severino said.
The rule has been controversial since it was proposed last year, and OCR received over 242,000 public comments, Severino said.
Proponents praise the rule
The regulation was welcomed by anti-abortion groups and Christian conservatives. “No one should be forced to participate in life-ending procedures like abortion or similar activities that go against their religious beliefs or moral convictions,” said Jeanne Mancini, president of March for Life, in an announcement.
BREAKING: President @realDonaldTrump announces new protections for conscience rights for #ProLife health care workers who refuse to participate in abortion:— Susan B. Anthony List (@SBAList) May 2, 2019
"Every child, born and unborn is a sacred gift from God."#StandWithNurses pic.twitter.com/cvckzYVVJZ
“No one should have to make the choice between violating their conscience—such as by ending a human life—and losing their job,” said Catherine Glenn Foster, president and CEO of Americans United for Life, a pro-life legal organization, in an emailed statement.
Live Action, an anti-abortion group, said the rule will protect pro-life healthcare workers. “Our country has long protected the rights of conscientious objectors. It is crucial we honor and respect the fact that our citizens still think for themselves,” said Lila Rose, the group’s founder and president. The law will ensure “that pro-life professionals will not face intimidation or professional repercussions because they refuse to participate in sterilization or ending human lives through abortion or assisted suicide.”
Critics raise objections
On the other side, opponents slammed the rule.
In a tweet, the National Partnership for Women & Families called it “a discriminatory rule that gives healthcare providers a free pass to discriminate against patients based on their personal beliefs.”
The Trump administration JUST finalized a discriminatory rule that gives health care providers a free pass to discriminate against patients based on their personal beliefs. #PutPatientsFirsthttps://t.co/4igbhOfURz— National Partnership (@NPWF) May 2, 2019
The Planned Parenthood Federation of America called the rule “dangerous” and said it puts patients’ health at risk, especially women and LGBTQ patients. In an emailed statement, the organization said the rule could result in a pharmacist turning away a patient seeking birth control or antidepressants because of personal beliefs or a pregnant woman being denied life-saving treatment because a hospital administrator personally believes the treatment could harm her pregnancy.
“My primary responsibility is to my patients; when I became a doctor, I took an oath to take care of them and provide the best medical care to them,” said Leana Wen, M.D., the group’s president. “In allowing doctors, nurses, and other healthcare providers to deny care to patients, the Trump-Pence administration is providing legal cover for discrimination.”
Fenway Health, a Boston health center that focuses on the LGBT community, said the rule will make it harder for LGBT people to access healthcare.
“It is important to view this latest move in the context of a series of attacks on the rights of LGBT patients that have taken place over the last two and a half years,” said Sean Cahill, director of health policy research at the Fenway Institute at Fenway Health, in an emailed statement.
The rule will put access to care in “grave danger” for millions of patients, the National Family Planning & Reproductive Health Association said in an emailed statement. “In the interest of patient care and public health, HHS must withdraw it,” said Clare Coleman, president and CEO.
“Turning anyone away from health services is immoral. Despite their claims, the Trump administration’s rule will harm LGBTQ people. Discrimination is insidious, sometimes guised as religion, which is why the National LGBTQ Task Force is working for full legal protections,” said Rea Carey, the group’s executive director.
The American Civil Liberties Union said the final rule will allow discrimination. “Denying patients healthcare is not religious liberty. Discriminating against patients based on their gender or gender expression is not religious liberty. Medical standards, not religious belief, should guide medical care,” said Louise Melling, deputy legal director.
In a tweet, Physicians for Reproductive Health, a doctor-led national advocacy organization, called the rule “outrageous.”
BREAKING: The Trump-Pence administration just finalized a rule that would allow personal beliefs to dictate patient care. This is outrageous. #PutPatientsFirst— PRH (@prhdocs) May 2, 2019
The National Women’s Law Center said the rule goes too far. “The Trump-Pence Administration will stop at nothing to strip patients of the care they deserve. This rule allows anyone from a doctor to a receptionist to entities like hospitals and pharmacies to deny a patient critical—and sometimes lifesaving—care. Personal beliefs should never determine the care a patient receives. This is a vicious and underhanded attack on the health and lives of patients, particularly targeting women and LGBTQ individuals,” said Fatima Goss Graves, the group’s president and CEO.
The Center for Reproductive Rights branded it the "Denial of Care Rule” rather than the “Conscience Right in Healthcare Rule."
“For decades, there have been well-oiled systems in place to make sure medical professionals can opt out of procedures that go against their beliefs. These systems respect religious liberty and make sure patients get the care they need. This new policy leaves zero safeguards for the patient,” said Susan Inman, the group’s chief counsel for federal policy and advocacy.
The rule, which takes effect 60 days after publication in the Federal Register, requires hospitals, universities, clinics and other institutions that receive funding from federal programs such as Medicare and Medicaid to certify that they comply with the 25 federal laws protecting conscience and religious rights.