Bush Official: Doctor's Right to Withold Info Greater Than Patient's Right to Receive It

Posted by Cara Kulwicki, The Curvature at 2:07 PM on March 27, 2008.

Surprise, surprise: the Bush Administration thinks that Ob/Gyns should not only have the right to deny women basic medical care like abortion, emergency contraception or regular old birth control, but they should also be able to refuse to provide a referral to another doctor for these services.

Last Friday, U.S. Health and Human Services Secretary Mike Leavitt sent a letter to the American Board of Obstetrics and Gynecology, with a copy to the American College of Obstetricians and Gynecologists.

Leavitt said he was concerned about an ethics committee statement from ACOG in November stating that doctors should either be prepared to perform "standard reproductive services" or else refer those patients to someone who will.

Leavitt's letter said he was even more concerned that the Ob/Gyn board had made adherence to that policy a requirement for certification.

Pro-life Ob/Gyns complained that that would require them to make abortion referrals, something they morally opposed. And in his letter, Leavitt said that could violate federal laws protecting health workers' conscience rights.

But here's the thing. Also shockingly, Leavitt is an idiot. Not only because he sent such an outrageous letter in response to such a practical guideline -- essentially stating that a person actually does have a right to medical care regardless of who their doctor prays to on Sunday -- but because the board in no way makes adherence to this commonsense guideline a requirement for certification. It should be a requirement, of course; I don't really know how the hell you could certify a doctor who refuses to provide his or her patients with basic information about services he or she doesn't like and expect an acceptable result. But the fact remains that it's not a requirement. And so Leavitt is not only an asshole who thinks doctors should be able to withhold information, he's also an asshole who doesn't bother to verify information before widely disseminating it.

But Norman Gant, executive director of the certifying board, says HHS got it all wrong.

"They took two and two and came up with five," he said.

Gant, who didn't respond sooner because he was out of the office, backed up what ACOG spokesman Gregory Phillips said Tuesday, which is that the ethics committee opinion regarding referrals is not a binding portion of the college's ethics code, and therefore not a factor in the decision about board certification.

"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," Gant said. "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."

Now, you'd think that a department which makes such a large and embarrassing blunder might show a bit of humility. But that'd be only if you don't know the Bush Administration. They actually think that even though the world's most basic and sensible ethical guideline is not a requirement for the certification of health care professionals, it should still be removed from their ethics statement. Not only do they not want the board to fail to enforce ethics, they also don't want the board to hurt the delicate sensibilities of the wingnut doctor club by even mentioning ethical practice at all.

On the other hand, Gant, himself an Ob/Gyn, said he personally had no problem with the November ethics statement, particularly the idea that Ob/Gyns should be ethically bound to provide contraception.

Apparently the Bush administration doesn't agree.

In an interview Tuesday, Principal Deputy Assistant Secretary for Health Don Wright said HHS would be relieved to find that the certifying board isn't using the ethics statement for certification decisions. As for the college, "We would still hope that they would revisit their position," Wright said.

Though a lot of this might sound like debate over hypothetical situations to the uninformed, we are dealing with a real problem, particularly when it comes to reproductive health care. Terrifyingly, a 2007 study showed that 63 percent of physicians believe that it is acceptable deny patients care and information based on their moral beliefs -- based on self-reporting, which means it's likely that the real numbers are even higher. In addition to doctors refusing to refer patients seeking abortions to an abortion provider, we're also dealing with EC refusal at the ER for rape victims, Catholic hospitals waiting to perform necessary abortions until the woman's life is actually in danger, pharmacists refusing to fill or transfer prescriptions for birth control pills, and maybe even doctors refusing to perform pap smears.

I have recently and repeatedly made my feelings clear on conscience clauses and the ways in which they are often used. I'm always amazed when anyone feels compelled to argue with me that it's perfectly okay for doctors and pharmacists to refuse to do their necessary and vital jobs for the public that depends on them -- and I blame our lack of universal health care for the common perception that medical care is somehow not a public service to which every individual has an innate human right. But the only thing worse than costing a patient extra money by sending them elsewhere, potentially making it impossible to get care due to travel concerns, denying a service that may be time-sensitive, and all around discriminating against women, is to refuse to even tell that woman where she can go to find a person who is not and asshole and willing to do their goddamn job. I'd like to think that even those who support the right of refusal to dispense EC, and the right of Catholic hospitals to exist at all when they're not going to provide equal and basic care, would agree with me there.

But our beloved government certainly doesn't. To them, the rights of each individual doctor to refuse medical care is more worthy of protection than right of their hundreds of patients to receive medical care. Once again, I'm disappointed and yet wholly unsurprised.

Tagged as: abortion, reproductive justice, healthcare

Cara Kulwicki is the founder of The Curvature, where she blogs daily about a wide range of feminist issues.