Medical Conscience Rule Has Much Wider Implications Than Reproductive Health Care

The rule could make basic access to health care unpredictable, especially for the poor.

A strong, healthy citizenry is essential to a nation’s economic and physical security, and health care is one of the key services by which a country’s quality of life is measured. It is already alarming that in 2000, the World Health Organization ranked the US health care system 37th in the world, and in 2007 the Commonwealth Fund found that the US health care system, despite being the most costly in the world, consistently underperformed in many critical areas. One can argue the details of these studies, what criteria were used, and how the criteria were defined. One can argue that tax laws, malpractice lawsuits, and insurance companies are major contributors to the problems in the US system. But one cannot argue away the fact that our health-care system has become ever more expensive year after year, while access and quality have diminished for many citizens. And now, as a parting gift to the American people, the Bush administration has passed the Medical Conscience Rule, a well-intentioned but poorly conceived effort which will likely serve – in unexpected ways – to worsen access to health care for those very patients most in need, with a disproportionate impact on the poor.

The rule prohibits federally-funded organizations from discriminating against health care workers who, because of their religious or moral convictions, refuse to participate in medical procedures. The rule has been both hailed and reviled as an escape for those health care providers who do not want to assist in abortions, and there has been much heated discussion on the rule’s impact on reproductive health issues. However, the draft rule is broad enough to cover any religious belief or moral conviction concerning any procedure, and that is really the larger problem.

One of my fellow lieutenants at my first assignment in Panama was a Christian Scientist. In keeping with her faith, she sought (and received) permission to forego the vaccinations which the Army normally requires for tropical assignments. Whether she would become ill or not, whether she would recover or not, and whether she might incur long-term damage or not, she left firmly in God’s hands. That is all well and good for an adult’s free and informed choice, and at any rate, I suspect you are unlikely to encounter a practicing Christian Scientist in the conventional health care system. But her case illustrates the point that there are many religious and moral convictions that revolve around the care of the physical body, which range far beyond reproductive health issues. Which ones will you encounter, and from whom?

Who, in light of this rule, can deny the moral grounds of a cancer specialist who refuses to treat smoking-related lung cancer, or the organ transplant surgeon who refuses a new liver to a dying alcoholic, saying that they have a moral obligation to use scarce resources for those whose diseases were not self-inflicted? For that matter, many people believe in bodily resurrection on Judgment Day, and therefore oppose body-altering procedures such as organ transplants; should such an individual be allowed to stand in the way of harvesting organs in accordance with a donor’s last wishes? Perhaps an emergency-room doctor has moral qualms about treating a drug-overdose victim who has been to the same hospital multiple times.

The possibilities are endless, and because this “conscience rule” is so highly flexible and individual in nature, there are major consequences that could impact availability of care. Moral objections concerning a patient’s situation carry the same weight as religious doctrine, and as a result, prospective patients will have no idea what to expect. The health care workers all look alike in their scrubs and clogs, but who among them will help the patient, and who among them will judge that the patient is somehow unworthy, or that the necessary procedure is somehow wrong?

All citizens have a right to basic, safe health care and should know what to expect from their providers. The US already is having some difficulty in providing basic access for all. This rule only introduces an additional element of uncertainty to the process, and further weakens the overall system.

The patients who will be most heavily impacted by this rule will be the users of the major federal programs: Medicaid (the poor), Medicare (mainly the over-65 crowd), and Tricare (the military, where many providers are actually civilians). Yet, many private facilities depend on some government funding, so this rule will affect virtually everyone to some degree. Even if you laud the protections the rule offers pro-life health care providers, the wider (much wider) implications should give pause.

Copyright R.N. Phillips, December 2008