Head of HHS Writes ACOG to Defend Physicians’ Right to Refuse Referrals on “Moral” Grounds
In November, the American College of Obstetricians and Gynecologists issued a statement on conscientious refusal [PDF], or the right of their member physicians to deny care based on their personal religious or ideological beliefs; they did not order that physicians treat all patients, but simply elaborated on the priorities of the well-being of the patient, the provision of unbiased and accurate information to the patient, notification of the patient of refusal of service, and the duty to refer patients to care elsewhere in a timely manner. They also noted that in emergency situations or areas in which limited care is available, physicians may need to be especially judicious about refusing care.
In December, I wrote about ACOG’s statement at Our Bodies Our Blog, noting that religious anti-choice groups responded with a letter to ACOG asking that they “repudiate and withdraw” the statement, and that the organization was sending “a message of ideological intolerance and religious discrimination.” I mused then that denying women legal care on religious grounds, to the extent of refusing to refer them to another care provider, was its own form of ideological intolerance – head on over to read more, especially regarding how the statement may have been either misunderstood or deliberately mischaracterized by these groups.
HHS Secretary Michael Leavitt has now jumped on the bandwagon, issuing a letter asking that ACOG ensure that their guidelines are not used to revoke physicians’ board certifications. ACOG, however, is not in charge of board certification – the American Board of Obstetrics and Gynecology is. At issue is ABOG’s 2008 Maintenance of Certification Bulletin [PDF], which indicates that an ob/gyn’s certification may be revoked for “licensure revocation by any State Board of Medical Examiners, violation of ABOG or ACOG rules and/or ethics principles or felony convictions.” An NPR reporter spoke to ACOG about the conscientious refusal statement, and was told by a spokesperson that the document is simply an opinion statement and “not a formal part of group’s code of ethics that board certified Ob/Gyns must obey.”
Leavitt also expresses concern that “forcing” physicians (although they don’t appear to be forced, just asked to think twice in emergencies and resource-poor areas) may violate federal non-discrimination laws; the necessary flipside of this conversation is what it means when patients can be discriminated against based on a provider’s religious beliefs. I think it’s also worth talking about what it means for the head of Health and Human Services to put forth this letter – is it a legitimate concern, based on the facts (it doesn’t appear that way, based on ACOG’s response), or is it a purely political move based on ideology instead of evidence and ethics? Discuss.
Update: NPR followed up and spoke with the executive director of ABOG, the certifying body, who said that HSS (Leavitt) “took two and two and came up with five.” He went to clearly explain that, “We do not restrict access to our exams for anyone applying for initial certification, or maintenance of certification, based on whether they do or do not perform an abortion. We do not base this upon whether they do or do not refer patients to an abortion provider if they do not choose to do abortions.” Director Gant also indicated that “he personally had no problem with the November ethics statement, particularly the idea that Ob/Gyns should be ethically bound to provide contraception.” The bottom line is that Leavitt’s well-publicized letter addressed a hypothetical problem that doesn’t exist, and probably could have been clarified with a phone call. An HHS lackey responded, “We would still hope that they would revisit their position.” Uh, sure.
Second Update: I forgot to mention that Leavitt has a blog. You won’t see this mentioned there.
[Hat tip to the Women's Bioethics Blog]